209 research outputs found
Hepatic Surgery Facilitated by a New Jet Dissector
Increasing experience with major hepatic resections has stimulated the development of improved
resectional techniques and tools. A new high velocity water jet dissector is reported which offers
significant advances over previously developed ultrasonic and low pressure water jet machines. It has
been successfully used in 8 major hepatic resections with minimal blood loss, excellent visibility and
without complications. The dissector is also of value in the exposure of intrahepatic bile ducts for biliaryenteric
anastomosis
Long Term Survival in a Patient Following Resection for Carcinoma of the Gallbladder and Rectum
We describe a 66-year-old man who presented initially with acute cholecystitis. He was treated by
cholecystostomy and biopsy of the gallbladder mucosa which revealed carcinoma of the gallbladder.
Four weeks later a cholecystectomy was performed followed by resection of the common bile duct,
common hepatic duct and segments IV and V of the liver and a hepaticojejunostomy. Sixteen months
later an abdomino-perineal resection was performed for a moderately differentiated Dukes′ stage C
carcinoma of the rectum. He is alive and without evidence of recurrence seven years later. Few patients
survive for this length of time following resection of either carcinoma of the gallbladder or rectum. This
case report demonstrates the value of aggressive surgical treatment in patients with early carcinoma of
the gallbladder
Pylorus-Preserving Pancreatoduodenectomy. Experience in 20 Patients
Twenty patients underwent a pylorus-preserving pancreatoduodenectomy for benign or malignant
periampullary and pancreatic disease. Eighteen patients had a partial and two patients a total
pancreatectomy. There were 19 elective and 1 emergency operations
Rectal Bleeding Associated With Chronic Pancreatitis
Pseudocyst formation, with its attendant complications of compression, rupture, bleeding and fistula formation, is a well known complication of chronic pancreatitis. In 1966 Berne and Edmondson drew attention to the often fatal outcome of pancreatico-colonic fistula complicated by hemorrhage. We present two cases of this rare complication of chronic pancreatitis as defined by the Marseille classification
Clinical Observation: Congenital Absence of the Left Portal Vein in a Patient Undergoing Hepatic Resection
Congenital absence of the left portal vein is a rare vascular anomaly with a reported prevalence varying from one in 62 to one in 507 cases. A patient admitted for recurrent cholangitis secondary to extensive dilation of the left biliary ductal system associated with Caroli's Disease was determined by preoperative dynamic CT to have an excessively large right portal vein and no left portal vein. The surgeon must be aware of any variations in portal vascular anatomy in patients undergoing hepatic resection in order to prevent potentially fatal postoperative complications
Chronic Rejection and Extrahepatic Biliary Tract Obstruction 8 Years After Orthotopic Liver Transplantation Using the Gallbladder-Conduit Technique
A case of delayed biliary obstruction and cholangitis, occurring in the setting of chronic allograft
rejection, 8 years after liver transplantation using the gallbladder-conduit, is presented. Extrahepatic
biliary obstruction may be seen in the late follow-up of liver grafting and rejection phenomena may play
a significant role in the development of such obstruction
Evaluation of Adaptive Changes by Non-Invasive Imaging in Hepatic Vein Outflow Obstruction
Hepatic vein outflow obstruction induces remarkable changes of intra–hepatic blood circulation;
the significance of these changes remains uncertain. Six patients with obstruction of the
hepatic veins were evaluated by duplex Doppler ultrasound and computed tomography. The
adaptive changes secondary to obstruction were analyzed and their significance was correlated
with the clinical findings. Four patients presenting unilateral hepatic vein occlusion had
unilateral reversed portal flow. Two of them, with lobar liver atrophy and contralateral
compensatory hypertrophy required operation; the other two, with normal appearance of the
liver, benefitted from conservative treatment. Two patients with bilateral hepatic vein occlusion,
intra-hepatic bypasses, bilateral lobar atrophy and caudate lobe hypertrophy, received operations.
Intrahepatic unilateral portal flow reversal compensates for unilateral hepatic outflow
obstruction. The combination of complete or subtotal hepatic vein obstruction and atrophy–hypertrophy
complex predicates advanced disease despite flow reversal or spontaneous shunt
Hepatic Resection Using a Water Jet Dissector
The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure,
high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty-seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The results showed no difference in operative duration (p = .499). The mean estimated blood loss using the water jet was 1386 ml, and tissue fracture technique 2450 ml (p = .217). Transfusion requirements were less in the water jet group (mean 2.0 units) compared to the tissue fracture group (mean 5.2 units); (p = .023). Results obtained with the new water dissector are encouraging. The preliminary results suggest that blood loss may be diminished
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