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Hepatic Surgery

Honorary Editors: Tan To Cheung, Long R. Jiao
Editors: Zhiming Wang, Giovanni Battista Levi Sandri, Alexander Parikh
Associate Editors: Yiming Tao, Michael D. Kluger, Romaric Loffroy

Hepatic Surgery

Honorary Editors: Tan To Cheung, Long R. Jiao
Editors: Zhiming Wang, Giovanni Battista Levi Sandri, Alexander Parikh
Associate Editors: Yiming Tao, Michael D. Kluger, Romaric Loffroy

AME Publishing Company

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First published in 2018
Printed in China by AME Publishing Company

Editors: Zhiming Wang, Giovanni Battista Levi Sandri, Alexander Parikh

Hepatic Surgery

(Hard Cover)
ISBN: 978-988-78919-1-8
AME Publishing Company, Hong Kong

AME Publishing Company has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

The advice and opinions expressed in this book are solely those of the authors and do not necessarily represent the views or practices of the publisher. No representation is made by the publisher about the suitability of the information contained in this book, and there is no consent, endorsement or recommendation provided by the publisher, express or implied, with regard to its contents.

I

Hepatic Surgery (FIRST EDITION)

Romaric Loffroy

HONORARY EDITORS

Department of Diagnostic Radiology and Image-guided Therapies, François-Mitterrand Teaching Hospital,

Tan To Cheung

Hepatobiliary, Pancreatic and liver Transplant Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
University of Bourgogne/Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon Cedex, France

Long R. Jiao

AUTHORS

HPB Surgical Unit, Department of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK

Arie Ariche

Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, TelAviv University, Tel-Aviv, Israel

EDITORS

Daniel Azoulay
Zhiming Wang

Department of General Surgery, Xiangya Hospital, Central South University, China
Department of Hepato-Biliary Surgery and Liver Transplantation, AP-HP, U.F.R. de médecine de l’Université Paris XII-Créteil, France

  • Giovanni Battista Levi Sandri
  • Hideo Baba

Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy; Department of Surgical Sciences, Advanced Surgical Technology, Sapienza, Italy
Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan

Barak Bar Zakai
Alexander Parikh

Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, TelAviv University, Tel-Aviv, Israel
Hepatobiliary, Pancreatic and GI Surgical Oncology, University of South Carolina School of Medicine – Greenville, 701 Grove Road, Greenville, SC 29605, USA

Jacques Belghiti

Hepato-Biliary and Pancreatic Surgery and Liver Transplantation Department, Beaujon Hospital, Assistance Publique-Hopitaux de Paris, Paris  II University, Clichy, France

ASSOCIATE EDITORS

Yiming Tao

Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha 410008, China

Andrea Belli

Division of Surgical Oncology, Department of Abdominal Oncology, “Istituto Nazionale Tumori Fondazione G. Pascale”-IRCCS, Naples 80131, Italy

Michael D. Kluger

Columbia University, College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY 10032, USA

Giulio Belli

Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Naples 80142, Italy

II

  • Enrico Benedetti
  • Olivier Chevallier

Division of Transplantation, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA
Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France

Roelof J. Bennink

Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands

Adrian Kah Heng Chiow

Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore

Toru Beppu

Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, Japan; Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan

Kasia P. Cieslak

Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

Luigi Ciof

Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Naples 80142, Italy

Kaitlyn Beyfuss

Division of General Surgery, Sunnybrook Health Sciences Centre—Odette Cancer Centre, Toronto, Ontario, Canada

Amir Cohen

Trauma Unit, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

Francesco Maria Bianco

Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA

Lidia Colace

Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy

Mirco Burocchi

Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy

Marco Colasanti

Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy

ꢀeljko Buꢁic

́

Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10000 Zagreb, Croatia
Philippe Compagnon Department of Hepato-Biliary Surgery and Liver Transplantation, AP-HP, U.F.R. de médecine de l’Université Paris XII-Créteil, France

Jean-Pierre Cercueil

Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France

Amanda B. Cooper

Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA

Chung Yip Chan

Kristijan Čupurdija

Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10000 Zagreb, Croatia

Tan To Cheung

Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China

Steven A. Curley

Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA

III

Michael I. D’Angelica

Ana Fajardo

Hepatopancreatobiliary Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
HPB Surgical Unit, Department of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK

Despoina Daskalaki

Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA

Ruifang Fan

HPB Surgical Unit, Department of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK

Giovanni de Manzoni

Division of General Surgery, University of Verona, Italy

Sylvain Favelier

Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France

Krstina Doklestic

́

Faculty of Medicine, University of Belgrade, Serbia; Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia

Yuman Fong
Annibale Donini

General Surgery, Department of Surgical Sciences, Radiology and Dentistry, University of Perugia, Italy
Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

Tamara M. H. Gall
Yael Dreznik

HPB Surgical Unit, Department of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK
Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Sophie Gehin

Antonija Đuzel

Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France
Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10000 Zagreb, Croatia

  • Rony Eshkenazy
  • Pierre-Yves Genson

Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, TelAviv University, Tel-Aviv, Israel
Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France

Louis Estivalet

Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France

Pier Cristoforo Giulianotti

Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA

  • Giuseppe Maria Ettorre
  • Luis Fernando Gonzalez-Ciccarelli

Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA

IV

  • Nathan Grimes
  • Aleksandar Karamarković

  • Royal Alexandra Hospital, Paisley, PA2 9PN, UK
  • Faculty of Medicine, University of Belgrade, Serbia;

Clinic for Emergency Surgery, Clinical Center of Serbia, Belgrade, Serbia

David N. Hakim

HPB Surgical Unit, Department of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK

Paul J. Karanicolas

Division of General Surgery, Sunnybrook Health Sciences Centre—Odette Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Julie Hallet

Institut Hospitalo-Universitaire (IHU) de Strasbourg, Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France; Institut de Recherche sur les Cancers de l’Appareil Digestif (IRCAD), Strasbourg, France; Division of General Surgery, Sunnybrook Health Sciences Centre—Odette Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Rondi Kauffmann

Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

Sajid A. Khan

Department of Surgery, the University of Chicago Medical Center, Chicago, IL 60637, USA

Hiromitsu Hayashi

Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan

Reza Kianmanesh

Department of General, Digestive and Endocrine Surgery, Hopital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France

Michal Heger

Department of Surgery, Surgical Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Jihun Kim

Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA

Masa Hrelec Patrlj

Department of Childrens’ Surgery, Clinical Hospital for Childrens’ Disease, Zagreb, Klaic

́

Yoram Klein

  • Croatia
  • Trauma Unit, Chaim Sheba Medical Center, Sackler School

of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

Takeaki Ishizawa

Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Japan; Hepato-Biliary- Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Robert Kliček

Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10000 Zagreb, Croatia

Michael D. Kluger
Long R. Jiao

Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY 10032, USA
HPB Surgical Unit, Department of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK

Norihiro Kokudo
Alexander Julianov

Department of Surgery, Trakia Universiry Hospital, Bulgaria
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

V

Marijan Kolovrat

Chetana Lim

Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10 000 Zagreb, Croatia
Department of Hepato-Biliary Surgery and Liver Transplantation, AP-HP, U.F.R. de médecine de l’Université Paris XII-Créteil, France

Mario Kopljar

Chung Mau Lo

Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10000 Zagreb, Croatia
Department of Surgery, The University of Hong Kong, Hong Kong, China

Romaric Loffroy

Denis Krause

Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France
Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François- Mitterrand Teaching Hospital, Dijon Cedex, France

Umberto Maggi
Eylon Lahat

Department of Hepato-Biliary Surgery and Liver Transplantation, AP-HP, U.F.R. de médecine de l’Université Paris XII-Créteil, France
Department of HPB Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel

Alexandre Malek
Alexis Laurent

Department of Hepato-Biliary Surgery and Liver Transplantation, AP-HP, U.F.R. de médecine de l’Université Paris XII-Créteil, France
Department of Hepato-Biliary Surgery and Liver Transplantation, AP-HP, U.F.R. de médecine de l’Université Paris XII-Créteil, France

Jacques Marescaux
Ser Yee Lee

IRCAD, Research Institute against Digestive Cancer, IHU, Institute for Image-Guided Surgery, 1 place de l’Hopital, 67091 Strasbourg, France
Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore

  • Pasquale Lepiane
  • Jeffrey B. Matthews

Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Lazio, Italy
Department of Surgery, the University of Chicago Medical Center, Chicago, IL 60637, USA

  • Universe Leung
  • John C. McAuliffe

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Hepatopancreatobiliary Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA

  • Giovanni Battista Levi Sandri
  • Riccardo Memeo

Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy; Department of Surgical Sciences, Advanced Surgical Technology, Sapienza, Italy
Institut Hospitalo-Universitaire (IHU) de Strasbourg, Institute for Minimally Hybrid Invasive Image-Guided Surgery, Université de Strasbourg, Strasbourg, France; Institut de Recherche sur les Cancers de l’Appareil Digestif (IRCAD), Strasbourg, France; General Digestive and Endocrine Surgery Service, Nouvel Hopital Civil, Strasbourg, France

Martin Lhuaire

Department of General, Digestive and Endocrine Surgery, Hopital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France

VI

  • Didier Mutter
  • Mislav Rakić

IRCAD, Research Institute against Digestive Cancer, IHU, Institute for Image-Guided Surgery, 1 place de l’Hopital, 67091 Strasbourg, France
Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10000 Zagreb, Croatia

Chandrasekhar Padmanabhan
Megan J. Reiniers

Division of Surgical Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
Department of Surgery, Surgical Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Alexander Parikh

Division of Surgical Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA

Franco Roviello

Surgical Oncology, Department of Human Pathology and Oncology, University of Siena, Italy

Leonardo Patrlj

Department of Abdominal Surgery, Surgical Clinic, Clinical Hospital Dubrava, Zagreb, Avenija Gojka Suuka 6, 10000 Zagreb, Croatia

Gianluca Russo

Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital, Naples 80142, Italy

  • Tim D. Pencavel
  • Akio Saiura

HPB Surgical Unit, Department of Surgery & Cancer, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Japan

  • Patrick Pessaux
  • Yasuo Sakamoto

IRCAD, Research Institute against Digestive Cancer, IHU, Institute for Image-Guided Surgery, 1 place de l’Hopital, 67091 Strasbourg, France
Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, Japan; Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan

Tullio Piardi

Department of General, Digestive and Endocrine Surgery, Hopital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France

Chady Salloum

Department of Hepato-Biliary Surgery and Liver Transplantation, AP-HP, U.F.R. de médecine de l’Université Paris XII-Créteil, France

Graeme Poston

Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool L9 7AL, UK; School of Cancer Studies, University of Liverpool, Liverpool L69, UK

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  • Liau-Report.Pdf

    Liau-Report.Pdf

    SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT KAREN AND JOSEF E. FISCHER INTERNATIONAL TRAVELING FELLOWSHIP FOR SURGEONS IN ACADEMIC PRACTICE 2018 REPORT Fellow: Siong-Seng Liau, MD, FRCS ‐ Addenbrooke’s Hospital, Cambridge, United Kingdom Travel Dates: Oct 31-November 13, 2018 Hosts: 1) Professor Sung-Gyu Lee, Division of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Centre, Seoul, South Korea 2) Professor Jin-Young Jang, Division of Hepatopancreatobiliary Surgery, Seoul National University Hospital, Seoul, South Korea 3) Professor Ho-Seong Han, Division of Hepatopancreatobiliary Surgery, Seoul National University Bundang Hospital, Seoul, South Korea Meeting: Annual Congress of Korean Surgical Society 2018 & 70th Congress of the Korean Surgical Society, Nov 1-3, Seoul, South Korea Report: I wish to thank Mrs Karen Fischer, Dr Josef Fischer, and the Society for Surgeons of the Alimentary Tract for this immense privilege to be the 2018 SSAT-Fischer International Travelling Fellow. I visited 3 major Hepatopancreatobiliary (HPB) centres in Seoul over the course of two weeks. This experience exceeded all my expectations. I planned this visit to focus on minimally- invasive HPB surgery. During this time, I witnessed a wide spectrum of HPB surgeries, including laparoscopic and robotic-assisted approaches. Seoul is indeed the ‘mecca’ of HPB surgery with the major HPB units in close vicinity to each other, making it convenient to visit each of these centres during the same fellowship. Further, I was able to coincide my fellowship with the Annual Congress of Korean Surgical Society, held annually in Seoul. My fellowship started at the Division of HPB Surgery and Liver Transplantation in Asan Medical Centre (AMC).
  • Anatomy of the Gallbladder and Bile Ducts

    Anatomy of the Gallbladder and Bile Ducts

    BASIC SCIENCE the portal vein lies posterior to these structures; Anatomy of the gallbladder the inferior vena cava, separated by the epiploic foramen (the foramen of Winslow) lies still more posteriorly, and bile ducts behind the portal vein. Note that haemorrhage during gallbladder surgery may be Harold Ellis controlled by compression of the hepatic artery, which gives off the cystic branch, by passing a finger through the epiploic foramen (foramen of Winslow), and compressing the artery Abstract between the finger and the thumb placed on the anterior aspect A detailed knowledge of the gallbladder and bile ducts (together with of the foramen (Pringle’s manoeuvre). their anatomical variations) and related blood supply are essential in At fibreoptic endoscopy, the opening of the duct of Wirsung the safe performance of both open and laparoscopic cholecystectomy can usually be identified quite easily. It is seen as a distinct as well as the interpretation of radiological and ultrasound images of papilla rather low down in the second part of the duodenum, these structures. These topics are described and illustrated. lying under a characteristic crescentic mucosal fold (Figure 2). Unless the duct is obstructed or occluded, bile can be seen to Keywords Anatomical variations; bile ducts; blood supply; gallbladder discharge from it intermittently. The gallbladder (Figures 1 and 3) The biliary ducts (Figure 1) The normal gallbladder has a capacity of about 50 ml of bile. It concentrates the hepatic bile by a factor of about 10 and also The right and left hepatic ducts emerge from their respective sides secretes mucus into it from the copious goblet cells scattered of the liver and fuse at the porta hepatis (‘the doorway to the throughout its mucosa.
  • The American Society of Colon and Rectal Surgeons Clinical Practice

    The American Society of Colon and Rectal Surgeons Clinical Practice

    CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the Prevention of Venous Thromboembolic Disease in Colorectal Surgery Fergal Fleming, M.D. • Wolfgang Gaertner, M.D. • Charles A. Ternent M.D. Emily Finlayson, M.D., M.S. • Daniel Herzig, M.D. • Ian M. Paquette, M.D. Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared by the Clinical Practice Guidelines Committee of The American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Surgeons ing the propriety of any specific procedure must be made is dedicated to ensuring high-quality patient care by the physician in light of all the circumstances presented Tby advancing the science, prevention, and manage- by the individual patient. ment of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is com- posed of society members who are chosen because they STATEMENT OF THE PROBLEM have demonstrated expertise in the specialty of colon and Venous thromboembolism (VTE), which includes deep rectal surgery. This committee was created to lead interna- venous thrombosis (DVT) and pulmonary embolism tional efforts in defining quality care for conditions related (PE), is a serious health problem in the United States, with to the colon, rectum, and anus. This is accompanied by de- an estimated 600,000 to 900,000 cases occurring annu- velopment of clinical practice guidelines based on the best ally.1,2 Venous thromboembolism is a common and often available evidence. These guidelines are inclusive but not morbid complication of any major surgery.
  • Your Guide to Colorectal Surgery

    Your Guide to Colorectal Surgery

    Your Guide to Colorectal Surgery Preparing for and Recovering from Surgery Patient Name Your Surgeon Index: Your Checklist ................................................... 2 Getting Ready for Surgery .............................. 7 The Day of Surgery .......................................... 18 Planning for Recovery and Going Home ...... 23 Concerns After Discharge .............................. 28 Notes ................................................................... 33 Important Contact Numbers.......................... Inside Back Cover ii | Your Guide to Colorectal Surgery Welcome to the Johns Hopkins Department of Surgery. Preparing for surgery can be overwhelming. You may be receiving a lot of information. Know that the Johns Hopkins colorectal surgery team is here to help you from beginning to end. This booklet includes details about: . Getting ready for your surgery . What to expect on the day of surgery and while recovering in the hospital . Planning for recovery and going home after surgery . What to expect once you are home It is important to remember that every patient is different. Your care team will tailor your recovery program to your needs. Please try to read this booklet as soon as you are able to and bring it with you to all of your appointments and hospitalizations. Keep track of your questions and be sure to ask your surgical team when you see them, or call our office at 410-955-7323, option 3. It is important for you, your family and your friends to understand what to anticipate so that everyone can fully participate in your recovery. Best wishes for a speedy recovery! The Johns Hopkins Colorectal Surgery Team Your Guide to Colorectal Surgery | 1 Your Checklist 2 | YYourour GuideGuide to to ColoColorrectalectal SurgeSurgerryy Y our Patient Name: Date of Surgery: Ch e cklist Use this summary checklist as a guide to what you need to do to prepare for your surgery and recovery after surgery.
  • Incidence and Risk Factors of Portomesenteric Venous Thrombosis

    Incidence and Risk Factors of Portomesenteric Venous Thrombosis

    Manigrasso et al. World Journal of Surgical Oncology (2019) 17:195 https://doi.org/10.1186/s12957-019-1739-9 RESEARCH Open Access Incidence and risk factors of portomesenteric venous thrombosis after colorectal surgery for cancer in the elderly population Michele Manigrasso1, Marco Milone1,2*, Nunzio Velotti3, Sara Vertaldi1, Pietro Schettino1, Mario Musella3, Giovanni Aprea1, Nicola Gennarelli1, Francesco Maione1, Giovanni Sarnelli1, Pietro Venetucci3, Giovanni Domenico De Palma1 and Francesco Milone3 Abstract Background: Although it is known that portomesenteric venous thrombosis (PMVT) is associated with total colectomy and proctocolectomy in young patients with inflammatory bowel disease, little is known about incidence and risk factors of PMVT among the elderly population undergoing colorectal surgery for cancer. Methods: Data of elderly patients (> 70 years) undergoing surgery for colorectal cancer were retrospectively registered. The occurrence of PMVT was correlated with the patients’ characteristics and operative variables. Data collected included age, sex, obesity, ASA score, tumor degree, type of surgical resection, surgical approach (laparoscopic or open), and duration of surgery (from skin incision to the application of dressings). Results: A total of 137 patients > 70 years who underwent surgery for colorectal cancer and developed an acute intraabdominal process with suggestive symptoms, needing a CT scan, were included. Three of these patients (2.1%) had portomesenteric venous thrombosis during the study period, which was proved with CT scan. There were no significant patients’ characteristics or operative variables between patients with or without the occurrence of PMVT after surgery. Of interest, only operative time was significantly higher in patients with PMVT after surgery (256 ± 40 vs 140 ± 41, p < 0.001).