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Il ruolo della chirurgia resettiva nella terapia del carcinoma epatocellulare su cirrosi.
No full textIs right hepatectomy for liver living donation really comparable to right hepatectomy for benign liver lesions?
No full textIs right hepatectomy for liver living donation really comparable to right hepatectomy for benign liver lesions?
No full textIntroduction: Right hepatectomy (RH) for adult to adult living liver donation
(LD) remains risky despite major progress in the last 10 years. In order to
elucidate factors explaining this lower tolerance of a standardized procedure
we prospectively studied the outcome of patients (pts) who underwent a RH
for benign lesions (BL) in comparison with RH for LD.
Materials and methods: From 2001 we studied prospectively the pre- and
post-operative data, including volumetric variations of 26 RH for BL. This
group was matched with 26 LD which underwent a RH in the same period.
The two groups (BL vs LD) were similar for age (43±11 vs 46±11 years),
sex and BMI (25±4 vs 23±3). All pts have the same pre- and post-operative
assessment (preoperative CT scan with volumetric measurements and study
of coagulation profi le, biological tests every day until POD 7, including an
abdominal CT scan on POD 7).
Results: The comparison of the two groups (BL vs LD) showed that operation
duration was longer in LD group (320±76 vs 382±65 min) (p=0.004). The
blood loss was similar (623±260 vs 590±350 mL). Postoperative biochemical
data showed that total serum bilirubin was signifi cantly higher in LD group
in POD 2, 3, 5 and 8. Morbidity classifi ed with the Clavien’s system was
similar in both groups 38% vs 42% p=ns. The mortality was nil. After
subtraction of the tumor’s volume (mean 421±530 cc) in the BL group the
total liver volume was similar in both groups (1438±226 vs 1460 ± 318 cc)
but the left remnant liver volume was higher in the BL group (650±216 vs
455±152 cc) (p<0.001) representing 35±7% in BL group vs 31±7% in LD
group (p=0.03). The ratio remnant weight/body weight was higher in BL pts
(1±0.32 vs 0.7±0.23) (p<0.001). At POD 7 the left remnant liver was similar
in the two groups (947 vs 862 cc) demonstrating a regeneration rate of 57%
in BL group as compared to 84% in LD group (p=0.009).
Conclusions: This study demonstrates that RH for LD is not comparable to
the same procedure in pts with BL. The left liver which is smaller in LD group
acquires the same volume at day 7 refl ecting a higher process of regeneration.
These results showing that in LD an important deprivation of liver volume
restored by a signifi cant and sudden regeneration in the fi rst postoperative
week may be the background promoting fatal complications
Liver endometriosis presenting as a liver mass associated with high blood levels of tumoral biomarkers.
No full textTen years of laparoscopic cholecystectomy: a comparison between a developed and a less developed country,
No full text-OBJECTIVE: To compare the specific features and outcomes of laparoscopic
cholecystectomy in two university hospitals, one in a developing country,
Bosnia-Herzegovina, and the other in a well developed country, Italy.
METHODS: Between January 1996 and December 2005, a total of 2018 patients
underwent laparoscopic cholecystectomy in Mostar Clinical Hospital,
Bosnia-Herzegovina (1066) and in Chieti University Hospital, Chieti, Italy (952).
Differences in patients' presentations, diagnostic protocols, medication,
surgical treatment, complications and outcomes were analyzed.
RESULTS: The number of patients with life-threatening conditions was lower in
Italy (15 or 1.5% vs. 53 or 4.9%; P<0.001), as was the use of analgesia and
antibiotics (131 or 13.96% vs. 873 or 81.97%; P<0.001). Open-access biliary
surgery was rare in Italy, where the vast majority of patients were operated
laparoscopically; only 44 (4.41%) patients had open-access surgery, including 35
(3.61%) conversion patients. In comparison, 1669 (61%) patients in
Bosnia-Herzegovina underwent open-access operations. There was a significant
difference, in favor of the Italian hospital, in the number of surgical
complications (8 or 0.84% vs. 40 or 3.75%; P<0.002) and also in the number of
postoperative infections following surgical incision (0 or 0.0% vs. 6 or 0.56%;
P<0.033).
CONCLUSIONS: It is encouraging for surgeons in Bosnia-Herzegovina to find that
satisfactory results can be achieved in a developing country. However, the number
of complications encountered in the Mostar hospital emphasizes the need for
further improvement of surgical technique through better structured training
combined with strict supervision of junior staff. The finding of postoperative
infections in the Bosnia-Herzegovina hospital, despite that their occurrence was
relatively rare, highlights the necessity for further improvement of hospital
infection control
Anastomotic site on donor bile duct does not influence biliary outcome after adult full size orthotopic liver transplantation
No full textBackground. Despite numerous technical improvements, incidence of bile
complications after orthotopic liver transplantation (OLT) is not decreasing.
End-to-end biliary anastomosis with or without drain is largely performed.
However there is no evidence that the anastomotic site on the donor bile duct
may infl uence the outcome.
Aims. To compare the outcome of end-to-end choledocho-hepaticostomy
(CHS) and end-to-end hepatico-hepaticostomy (HHS) for biliary
reconstruction after adult cadaveric full size OLT.
Methods. From 2006 to 2009, 125 adult liver recipients of a full size liver
graft underwent end-to-end biliary reconstruction. If bleeding from the
choledochal wall was obvious and cystic junction was high enough, the
donor bile duct was cross-sectioned below the cystic junction, and a CHS
was performed, drained by a transcystic external drain (C-tube). In the other
cases, the donor bile duct was cross-sectioned above the cystic junction and a
HHS was performed with insertion of a T-tube in case of major incongruence
between graft and recipient ducts.
Results. 77 patients (62%) underwent CHS with C-tube, whereas 48 patients
underwent HHS (38%), with T-tube inserted in 18 cases. The 2 groups (CHS
vs HHS) were comparable regarding age (55+/-9 vs 54+/-9; p=0.5), sex
(M= 74% vs M= 67%; p=0.2), BMI (25+/-4 vs 26+/-5; p=0.8) and MELD
(16+/-8 vs 18+/-10; p=0.2). Indications for OLT were cancer (51% vs 37%),
alcohol (30% vs 46%), viral hepatitis (8% vs 6%) and other (12% vs 10%).
The median follow-up was 23 months. There were no difference between
groups in overall biliary complication rate (22% vs 21%; p=0.9), biliary
leak (4% vs 6%; p=0.5) and stenosis (10% vs 6%; p=0.4). The incidence of
choleperitoneum after bile drain removal was similar between patients with
C-tube and T-tube (6% vs 4%; p=0.8).
Conclusions. Bile duct reconstruction could be safely performed on donor
common bile duct, providing that vascularization of the biliary section and
anatomy of the cystic junction are adequate. CHS should be preferred to
HHS whenever possible because of the larger diameter of the common bile
duct and the avaliability of the donor cystic duct which allows easily the
insertion of a bile drain
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