The Relationship Between Hospital Volume and Outcomes of Hepatic Resection for Hepatocellular Carcinoma
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Review Article Laparoscopic Versus Open Live Donor Hepatectomy in Liver Transplantation: a Systemic Review and Meta-Analysis
Int J Clin Exp Med 2016;9(8):15004-15016 www.ijcem.com /ISSN:1940-5901/IJCEM0021495 Review Article Laparoscopic versus open live donor hepatectomy in liver transplantation: a systemic review and meta-analysis Dong-Wei Xu*, Ping Wan*, Jian-Jun Zhang, Qiang Xia Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China. *Equal contributors. Received December 9, 2015; Accepted March 19, 2016; Epub August 15, 2016; Published August 30, 2016 Abstract: Objective: The aim of this study was to compare laparoscopic versus open live donor liver transplantation using meta-analysis. Background: Living donor liver transplantation (LDLT), as an alternative to deceased donor liver transplantation (DDLT), has increasingly performed all around the world. Laparoscopic live donor hepatectomy (LLDH) has been performed increasingly, and is gaining worldwide acceptance. As the studies assessing the safety and efficacy of laparoscopic compared with open techniques is growing, we combined the available data to conduct this meta-analysis to compare the two techniques. Methods: A literature search was performed to identify studies comparing laparoscopic with open live donor hepatectomy (OLDH) published before June 2015. Perioperative out- comes (blood loss, operative time, hospital stay, analgesia use) and postoperative complications (donors and reci- pients postoperative complications, recipients specific postoperative complications including biliary complications and vascular complications) were the main outcomes evaluated in the meta-analysis. Results: Fourteen studies with a total of 1136 patients were included in this meta-analysis, of which 357 were treated by laparoscopic technique and 779 were treated by the open procedures. Compared with the open group, laparoscopic group was associated with significant less estimated blood loss (P=0.01), shorter duration of operation (P=0.02), length of hospital stay (P=0.003) and duration of PCA use (P=0.04). -
About Liver Resection
ABOUT LIVER RESECTION Surgical removal of part of the liver A guide for patients and relatives This booklet has been written to provide information about the operation called a liver resection. This is a major operation and involves removal of a part of the liver. Information about the benefits and risks will help you make an informed decision about the operation. It is important to remember that each person is different. This booklet cannot replace the professional advice and expertise of a doctor who is familiar with your condition. If you have questions that this booklet does not cover, please discuss them with your surgeon or cancer nurse specialist. page 2 What is the liver? The liver is a large organ which lies on the right side of the upper abdomen, under the rib cage. It has many functions related to body metabolism (chemical processes within the body) and is very important to health. One of its functions is to produce yellow-green fluid called bile. Bile flows down a tube called the bile duct to the intestine, where it mixes with food and helps digestion. The gall bladder is a small sac attached to the side of the bile duct. The gall bladder stores excess bile and pushes it down the bile duct in to the intestine, ready for when it is needed for digestion. The liver has right and left lobes (sections). An artery (hepatic artery) and a vein (portal vein) carry blood to the liver. Blood from the liver flows through the hepatic veins back to the heart. -
Management of Autoimmune Liver Diseases After Liver Transplantation
Review Management of Autoimmune Liver Diseases after Liver Transplantation Romelia Barba Bernal 1,† , Esli Medina-Morales 1,† , Daniela Goyes 2 , Vilas Patwardhan 1 and Alan Bonder 1,* 1 Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; [email protected] (R.B.B.); [email protected] (E.M.-M.); [email protected] (V.P.) 2 Department of Medicine, Loyola Medicine—MacNeal Hospital, Berwyn, IL 60402, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-617-632-1070 † These authors contributed equally to this project. Abstract: Autoimmune liver diseases are characterized by immune-mediated inflammation and even- tual destruction of the hepatocytes and the biliary epithelial cells. They can progress to irreversible liver damage requiring liver transplantation. The post-liver transplant goals of treatment include improving the recipient’s survival, preventing liver graft-failure, and decreasing the recurrence of the disease. The keystone in post-liver transplant management for autoimmune liver diseases relies on identifying which would be the most appropriate immunosuppressive maintenance therapy. The combination of a steroid and a calcineurin inhibitor is the current immunosuppressive regimen of choice for autoimmune hepatitis. A gradual withdrawal of glucocorticoids is also recommended. Citation: Barba Bernal, R.; On the other hand, ursodeoxycholic acid should be initiated soon after liver transplant to prevent Medina-Morales, E.; Goyes, D.; recurrence and improve graft and patient survival in primary biliary cholangitis recipients. Unlike the Patwardhan, V.; Bonder, A. Management of Autoimmune Liver previously mentioned autoimmune diseases, there are not immunosuppressive or disease-modifying Diseases after Liver Transplantation. -
Liver Transplantation As Last-Resort Treatment for Patients with Bile Duct Injuries Following Cholecystectomy: a Multicenter Analysis
ORIGINAL ARTICLE Annals of Gastroenterology (2020) 33, 1-8 Liver transplantation as last-resort treatment for patients with bile duct injuries following cholecystectomy: a multicenter analysis Peter Tsaparasa, Nikolaos Machairasa, Victoria Ardilesb, Marek Krawczykc, Damiano Patronod, Umberto Baccaranie, Umberto Cillof, Einar Martin Aandahlg, Christian Cotsoglouh, Johana Leiva Espinozab, Rodrigo Sanchez Claríab, Ioannis D. Kostakisa, Aksel Fossg, Vincenzo Mazzaferroh, Eduardo de Santibañesb, Georgios C. Sotiropoulosa,i Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Medical University of Warsaw, Poland; University of Torino, Turin, Italy; University of Udine, Udine, Italy; University of Padova School of Medicine, Padova, Italy; Oslo University Hospital, Oslo, Norway; University of Milan, Milan, Italy; University Hospital Essen, Germany Abstract Background Liver transplantation (LT) has been used as a last resort in patients with end-stage liver disease due to bile duct injuries (BDI) following cholecystectomy. Our study aimed to identify and evaluate factors that cause or contribute to an extended liver disease that requires LT as ultimate solution, after BDI during cholecystectomy. Methods Data from 8 high-volume LT centers relating to patients who underwent LT after suffering BDI during cholecystectomy were prospectively collected and retrospectively analyzed. Results Thirty-four patients (16 men, 18 women) with a median age of 45 (range 22-69) years were included in this study. Thirty of them (88.2%) underwent LT because of liver failure, most commonly as a result of secondary biliary cirrhosis. The median time interval between BDI and LT was 63 (range 0-336) months. There were 23 cases (67.6%) of postoperative morbidity, 6 cases (17.6%) of post-transplant 30-day mortality, and 10 deaths (29.4%) in total after LT. -
The Evolution of Minimally Invasive Surgery in Liver Transplantation for Hepatocellular Carcinoma
Sioutas et al. Hepatoma Res 2021;7:26 Hepatoma Research DOI: 10.20517/2394-5079.2020.111 Review Open Access The evolution of minimally invasive surgery in liver transplantation for hepatocellular carcinoma Georgios S. Sioutas1, Georgios Tsoulfas2 1School of Medicine, Democritus University of Thrace, Alexandroupolis 68100, Greece. 2First Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece. Correspondence to: Prof. Georgios Tsoulfas, First Department of Surgery, Aristotle University of Thessaloniki, 66 Tsimiski Street, Thessaloniki 54622, Greece. E-mail: [email protected] How to cite this article: Sioutas GS, Tsoulfas G. The evolution of minimally invasive surgery in liver transplantation for hepatocellular carcinoma. Hepatoma Res 2021;7:26. https://dx.doi.org/10.20517/2394-5079.2020.111 Received: 24 Sep 2020 First Decision: 19 Nov 2020 Revised: 22 Nov 2020 Accepted: 26 Nov 2020 Available online: 9 Apr 2021 Academic Editor: Ho-Seong Han Copy Editor: Cai-Hong Wang Production Editor: Jing Yu Abstract Hepatocellular carcinoma (HCC) is a malignant neoplasm associated with significant mortality worldwide. The most commonly applied curative options include liver resection and liver transplantation (LT). Advances in technology have led to the broader implementation of minimally invasive approaches for liver surgery, including laparoscopic, hybrid, hand-assisted, and robotic techniques. Laparoscopic liver resection for HCC or living donor hepatectomy in LT for HCC are considered to be feasible and safe. Furthermore, the combination of laparoscopy and LT is a recent impressive and promising achievement that requires further investigation. This review aims to describe the role of minimally invasive surgery techniques utilized in LT for HCC. -
Bariatric Surgery and Liver Transplantation
MAYO CLINIC Bariatric Surgery and Liver Transplantation Julie Heimbach, MD Professor and Chair, Transplantation Surgery Mayo Clinic, Rochester, MN [email protected] MAYO CLINIC Objectives • Outline current scope of the obesity epidemic • Implications of NASH pre and post LT • Discuss the role of bariatric surgery How can we best care for the obese liver transplant candidate? - World wide, obesity has doubled since 1980 - Currently, 600 million obese adults in the world MAYO CLINIC Why? • Clinical need for a different approach 4 MAYO CLINIC NASH as an indication for listing for liver transplantation in US Wong et al Gastro 2015; 148: 547-55. 5 MAYO CLINIC Why? • 57 year old male, BMI 52, MELD 30, referred to hospice by his local transplant center • LT+SG (MELD =40), current BMI=34 stable 3 years post LT • “One day I am dying, the next week I am not,” he said. “That just doesn’t happen.” 6 MAYO CLINIC Why? • Structured approach to the problem • Allows patients to return to full function– as transformative as transplant • Reduces the long-term complications of obesity 7 MAYO CLINIC Impact of obesity on pre-transplant patient selection • Most common cause of death for patients with NAFLD is a cardiovascular event. • Patients who undergo LT for NASH may be at an increased risk for perioperative/post-op cardiac events • Sarcopenia is associated with worse outcomes, including patients with sarcopenic obesity Ekstadt et al Hepatology 2006:4;865-73. Vanwagner et al Hepatology. 2012 Nov;56(5):1741-50 Choudary et al Clin Transplant 2015: 29: 211–215. -
Liver Resections Combined with Closure of Loop Ileostomies: a Retrospective Analysis
Hindawi Publishing Corporation HPB Surgery Volume 2008, Article ID 501397, 5 pages doi:10.1155/2008/501397 Research Article Liver Resections Combined with Closure of Loop Ileostomies: A Retrospective Analysis Jeffrey T. Lordan, Angela T. Riga, and Nariman D. Karanjia Regional Hepato-Pancreatico-Biliary Unit for Surrey and Sussex, The Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK Correspondence should be addressed to Jeffrey T. Lordan, dr [email protected] Received 6 August 2008; Accepted 30 October 2008 Recommended by Olivier Farges Background. The management of patients with colorectal liver metastases and loop ileostomies remains controversial. This study was performed to assess the outcome of combined liver resection and loop ileostomy closure. Methods. Analysis of prospectively collected perioperative data, including morbidity and mortality, of 283 consecutive hepatectomies for colorectal liver metastases was undertaken. Consecutive liver resections were performed from 1996 to 2006 in one centre by a single surgeon (NDK). Fourteen of these patients had combined liver resection and ileostomy closure. Case-matched analysis was undertaken. Results.Six(2.2%) patients died in the hepatectomy only group and none died in the combined group. There was no difference in operative blood loss between the two groups (0.09). Perioperative morbidity was 36% in the combined group and 23% in the hepatectomy alone group (P = 0.33). Mean hospital stay was 14 days in the combined group and 11 days in the hepatectomy only group (P = 0.046). Case-matched analysis showed a significant increase in hospital stay (P = 0.03) and complications (P = 0.049) in the combined group. -
Intestinal and Multivisceral Transplant Reference Number: CP.MP.58 Coding Implications Last Review Date: 05/20 Revision Log
Clinical Policy: Intestinal and Multivisceral Transplant Reference Number: CP.MP.58 Coding Implications Last Review Date: 05/20 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Medical necessity criteria for the review of intestinal and multivisceral transplant requests. Policy/Criteria It is the policy of health plans affiliated with Centene Corporation® that any of the intestinal and/or multivisceral transplantation procedures listed in I are medically necessary for pediatric and adult members to restore function in those with irreversible intestinal failure when meeting the criteria in section II: I. Transplantation Procedures A. Isolated intestinal transplantation is indicated for members who have only isolated intestinal failure and no liver disease. B. Combined intestinal and liver transplant is indicated in those with intestinal failure and end stage liver disease. C. Multivisceral transplant is indicated in those with intestinal failure and gastrointestinal motility disorders (e.g., chronic idiopathic intestinal pseudo-obstruction, visceral myopathy, visceral neuropathy, total intestinal aganglionosis, and some forms of mitochondrial respiratory chain disorders that affect gastrointestinal motor function), or extensive mesenteric thrombosis. II. Procedure Criteria: Members must have one of the indications in A and none of the contraindications in B: A. Indications, any one of the following: 1. Failure of total parenteral nutrition (TPN) as indicated by one of the following: a. Impending or overt liver failure due to TPN, indicated by elevated serum bilirubin and/or liver enzymes, splenomegaly, thrombocytopenia, gastro-esophageal varices, coagulopathy, peristomal bleeding, or hepatic fibrosis/cirrhosis; b. Thrombosis of ≥ 2 central veins, including jugular, subclavian, and femoral veins; c. -
793 H. Chen (Ed.), Illustrative Handbook of General Surgery, DOI
Index A anesthetization , 763 Abdominoperineal resection incision , 763, 764 (APR) informed consent , 762 anesthesia , 432–433 packing abscess cavity , indications , 430–431 764, 765 patient positioning , 432 potential risks, disclosure post-operative care , 446 of , 762 pre-operative imaging and protective equipment , 762 procedures , 431–432 skin preparation , 763 procedure A C C . See Adrenocortical cancer anococcygeal ligament , (ACC) 441, 442 Achalasia . See Esophageal anterior dissection plane , achalasia 442, 444 Adjustable gastric banding elliptical incision , 441 (AGB) , 237, 244–245 perineal incision , 442, 445 Adrenalectomy robotic , 445–446 indications for , 62 Abscess drainage laparoscopic (see anesthesia , 761–762 (Laparoscopic antibiotic therapy , 759 adrenalectomy) ) complications , 766 open (see (Open indications , 760 adrenalectomy) ) patient positioning , 761 Adrenal incidentaloma , 63 post-procedure Adrenocortical cancer (ACC) instructions , 766 laparoscopic adrenalectomy pre-procedure evaluation , (see (Laparoscopic 760–761 adrenalectomy) ) procedure open adrenalectomy (see abscess cavity, loculations (Open of , 764, 765 adrenalectomy) ) H. Chen (ed.), Illustrative Handbook of General Surgery, 793 DOI 10.1007/978-3-319-24557-7, © Springer International Publishing Switzerland 2016 794 Index A G B . See Adjustable gastric Antirefl ux procedure (ARP) , 194 banding (AGB) Dor fundoplication Aldosterone producing advantages of , 200 adenoma , 71 completion of , 201–202 American College of creation of , 200–201 Radiologists -
Technical Aspects of Orthotopic Liver Transplantation for Hepatocellular Carcinoma
Technical Aspects of Orthotopic Liver Transplantation for Hepatocellular Carcinoma a a,b, Lung-Yi Lee, MD , David P. Foley, MD * KEYWORDS Liver transplantation Surgery Hepatocellular carcinoma Piggyback technique Portal vein thrombosis KEY POINTS In the majority of cases, patients with cirrhosis and hepatocellular carcinoma (HCC) who undergo liver transplantation are transplanted based on their higher Model for End-Stage Liver Disease (MELD) exception score and not their physiologic MELD score; this usually results in fewer physiologic derangements during liver transplantation. Patients who have previously undergone locoregional therapy or liver resection for HCC can develop significant perihepatic adhesions that increase the complexity of the hepa- tectomy during transplant. Implantation strategy of the inferior vena cava (IVC) during liver transplant may need to be modified based on location of previously treated HCC. Patients who undergo transarterial chemoembolization for pretransplant HCC therapy may have higher rates of hepatic artery thrombosis after liver transplant; therefore, aorto- hepatic bypass grafting with donor iliac artery may be required for arterial in flow to the liver allograft. Patients with portal vein (PV) thrombosis with a bland thrombus and a patent superior mesenteric vein (SMV) can undergo successful liver transplant through either PV throm- bectomy and standard end-to-end PV-PV anastomosis, or the use of SMV-PV bypass graft with donor iliac vein. a Department of Surgery, University of Wisconsin School of Medicine and Public Health, Clinical Sciences Center, H4/766, 600 Highland Avenue, Madison, WI 53792-3284, USA; b Veterans Administration Surgical Services, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA * Corresponding author. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Dorsal Approach with Glissonian Approach for Laparoscopic Right
Wang et al. BMC Gastroenterol (2021) 21:138 https://doi.org/10.1186/s12876-021-01726-4 TECHNICAL ADVANCE Open Access Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections Shaohe Wang1,2, Yang Yue1, Wenjie Zhang1, Qiaoyu Liu1, Beicheng Sun1, Xitai Sun1 and Decai Yu1* Abstract Background: Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. How- ever, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods: Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively ana- lysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparo- scopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected frstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the periph- eral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results: The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 58.2 min and the mean estimated volume of blood loss was 412.5 255.4 mL. The mean duration of postoperative± hospital stay was 10.2 days.