1,721,012 research outputs found
Laparoscopic Management of Hepatocellular Carcinoma: A Critical Reappraisal
No full textFollowing the introduction of the first laparoscopic liver resection, after similar to 25 years, a critical reappraisal seems to be warranted. Liver resection represents the first choice for curing early hepatocellular carcinoma (HCC) allowing a curative chance also in selected patients with intermediate stage tumors. The criteria for liver resectability by laparoscopy remains the same for open surgery, which is oncological criteria (absence of extrahepatic tumor location; completely resectable R0 resection), anatomic (resectability of involved segment with its own blood surely and biliary drainage; absence of vascular invasion of portal or hepatic veins) and technical (possibility to leave in place a residual volume >= 40%). Anatomic resections being more challenging than wedged resections, were initially performed mainly for lesions located in the left liver (segments 2, 3, and 4) and segments 5 and 6 of the right liver (anterior and lateral hepatic segments). Left lateral segmentectomy seemed most suited for laparoscopic resection because of the thinness of the liver, the possibility of resection without hilar dissection, ease of stapling the left hepatic vein and portal pedicles of segment II and III by mechanical stapling. Conversely, right hepatectomy seemed most difficult and technically challenging to perform. The analysis of literature confirms that minor liver resections for HCC can be safely conducted also in cirrhotic patients and that laparoscopy, when feasible, should be the approach of first choice. As mentioned, there have been several studies that compared the long-term outcomes of laparoscopic hepatectomy (LH) versus open hepatectomy for HCC, even in cirrhotic patients, showing that laparoscopy does not seem to have any impact on the risk of postoperative HCC recurrence. However, further studies seem to be required, especially for long-term oncological results and for major hepatectomy, before LH become a common alternative to open liver surgery. The practice of performing LH (major) is challenging, due to the significant complexity of these interventions
Survival analysis after pancreatic resection for ampullary and pancreatic head carcinoma: an analysis of clinicopathological factors.
No full textPreoperative Superselective Mesenteric Angiography and Methylene Blue Injection for Localization of Obscure Gastrointestinal Bleeding
No full textLocalizing obscure gastrointestinal bleeding can be a clinical challenge, despite the availability of various endoscopic, imaging, and visceral angiographic techniques. We reviewed the management of patients presenting with obscure gastrointestinal bleeding during the period from 2005 to 2011. Four patients had preoperative localization of the bleeding site with superselective mesenteric angiography, which was confirmed by the use of intraoperative methylene blue injection. This novel technique allowed us to identify the abnormal pathology, and, consequently, resection of the implicated segment of small bowel was performed without any postoperative complications. Final histology showed that 2 patients had arteriovenous malformations: one had a benign hemangioma of the small bowel, and the other had chronic ischemic ulceration in the ileum. Superselective mesenteric angiography combined with intraoperative localization with methylene blue is an important and innovative technique in the management of patients with unclear sources of gastrointestinal bleeding and allows for effective hemorrhage control with a focused and therefore limited bowel resection
Bile duct instrumentation predispose sto biliary infection and its related complications but not mortality
No full textIs positive intra-operative bile culture a determinant factor for postoperative morbidity and mortality after biliary pancreatic surgery?
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