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Jang SI, Lee DK. Anastomotic stricture after liver transplantation: It is not Achilles' heel anymore! INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Hu B, Sun B. Response. Gastrointest Endosc 2018; 87:323. [PMID: 29241863 DOI: 10.1016/j.gie.2017.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Bing Hu
- Department of Gastroenterology and Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Bo Sun
- Department of Gastroenterology and Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
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Vicentine FPP, Gonzalez AM, Beninni BB, Azevedo RAD, Linhares MM, Goldenberg A, Lopes GDJ, Martins JL, Salzedas AA. Use of fibrinogen and thrombin sponge in pediatric split liver transplantation. Acta Cir Bras 2017; 32:673-679. [PMID: 28902943 DOI: 10.1590/s0102-865020170080000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/18/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.
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Affiliation(s)
- Fernando Pompeu Piza Vicentine
- Fellow PhD degree, Postgraduate Program in Interdisciplinary Surgical Sciences, Universidade Federal de São Paulo (UNIFESP), Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; statistics analysis; final approval of the version to be published
| | - Adriano Miziara Gonzalez
- PhD, Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; drafting the article; technical procedures, final approval of the version to be published
| | - Barbara Burza Beninni
- Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study; acquisition, analysis and interpretation of data
| | - Ramiro Anthero de Azevedo
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
| | - Marcelo Moura Linhares
- PhD, Associate Professor, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; drafting the article; technical procedures, final approval of the version to be published
| | - Alberto Goldenberg
- PhD, Chairman, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study, final approval of the version to be published
| | - Gaspar de Jesus Lopes
- PhD, Chairman, Division of Surgical Gastroenterology, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Intellectual content of the study, final approval of the version to be published
| | - Jose Luiz Martins
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
| | - Alcides Augusto Salzedas
- PhD, Associate Professor, Division of Pediatric Surgery, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, analysis and interpretation of data, final approval of the version to be published
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Vicentine FPP, Gonzalez AM, Azevedo RAD, Benini BB, Linhares MM, Lopes-Filho GDJ, Martins JL, Salzedas-Netto AA. PEDIATRIC LIVER TRANSPLANTATION WITH EX-SITU LIVER TRANSECTION AND THE APPLICATION OF THE HUMAN FIBRINOGEN AND THROMBIN SPONGE IN THE WOUND AREA. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29:236-239. [PMID: 28076477 PMCID: PMC5225862 DOI: 10.1590/0102-6720201600040006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/30/2016] [Indexed: 01/13/2023]
Abstract
Background Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion There was a lower number of reoperations due to bleeding of the wound area of the hepatic graft when the human fibrinogen and thrombin sponge were used.
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Affiliation(s)
- Fernando Pompeu Piza Vicentine
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Adriano Miziara Gonzalez
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | | | - Barbara Burza Benini
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Marcelo Moura Linhares
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Gaspar de Jesus Lopes-Filho
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Jose Luiz Martins
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Alcides Augusto Salzedas-Netto
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
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Patient Selection and Surgical Management of High-Risk Patients with Morbid Obesity. Surg Clin North Am 2016; 96:743-62. [DOI: 10.1016/j.suc.2016.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Pargewar SS, Desai SN, Rajesh S, Singh VP, Arora A, Mukund A. Imaging and radiological interventions in extra-hepatic portal vein obstruction. World J Radiol 2016; 8:556-70. [PMID: 27358683 PMCID: PMC4919755 DOI: 10.4329/wjr.v8.i6.556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/26/2016] [Accepted: 03/17/2016] [Indexed: 02/06/2023] Open
Abstract
Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.
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Tokodai K, Kawagishi N, Miyagi S, Nakanishi C, Hara Y, Fujio A, Kashiwadate T, Kanno A, Goto H, Kamei T, Ohuchi N. Indications and outcomes of an endoscopic approach under laparotomy for the treatment of bilioenteric anastomotic strictures. Pediatr Transplant 2016; 20:316-20. [PMID: 26694626 DOI: 10.1111/petr.12655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 01/31/2023]
Abstract
BAS is a potentially life-threatening complication of LDLT. The aim of this study was to report on the indications and outcomes of an endoscopic approach under laparotomy being used in our institution to treat BAS after LDLT, using hepaticojejunostomy, for a small case series. Eighty-three patients underwent an LDLT in our institution between 1991 and 2014. Retrospective chart review indicated that 10 of these patients developed BAS and were included in our analysis. The endoscopic approach under laparotomy was used in three patients who developed BAS 10 yr or more after their LDLT and in whom a percutaneous transhepatic approach and an endoscopic approach had failed. The course of recovery post-operatively was unremarkable for two of the three patients who underwent the endoscopic approach under laparotomy. One patient required follow-up laparotomy to treat a perforation of the bowel causing acute peritonitis. At follow-up one yr post-operatively, the stent tube was removed in two patients who recovered fully. The other patient had full recovery with the stent remaining in situ. The endoscopic approach under laparotomy could be a safe and promising option in the treatment of BAS to avoid surgical re-anastomosis.
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Affiliation(s)
- Kazuaki Tokodai
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Naoki Kawagishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Shigehito Miyagi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Chikashi Nakanishi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Yasuyuki Hara
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Atsushi Fujio
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Toshiaki Kashiwadate
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Atsushi Kanno
- Department of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Hitoshi Goto
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Takashi Kamei
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Noriaki Ohuchi
- Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan
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Ludwig JM, Webber GR, Knechtle SJ, Spivey JR, Xing M, Kim HS. Percutaneous Management of Benign Biliary Strictures with Large-Bore Catheters: Comparison between Patients with and without Orthotopic Liver Transplantation. J Vasc Interv Radiol 2016; 27:219-225.e1. [DOI: 10.1016/j.jvir.2015.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
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The role of interventional radiology in complications associated with liver transplantation. Clin Radiol 2015; 70:1323-35. [DOI: 10.1016/j.crad.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/21/2015] [Accepted: 07/08/2015] [Indexed: 02/07/2023]
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Lazzati A, Iannelli A, Schneck AS, Nelson AC, Katsahian S, Gugenheim J, Azoulay D. Bariatric surgery and liver transplantation: a systematic review a new frontier for bariatric surgery. Obes Surg 2015; 25:134-42. [PMID: 25337867 DOI: 10.1007/s11695-014-1430-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study aims to conduct a systematic review on bariatric surgery (BS) for patients in the setting of liver transplantation (LT). A literature review was conducted on the PubMed, Embase, and Cochrane Library databases. Studies in the English language on adults reporting on BS prior to, during, or after LT were included. Eleven studies with 56 patients were retrieved. Two studies reported on BS before, two during, and seven after LT. Sleeve gastrectomy was the most common procedure, followed by Roux-en-Y gastric bypass, biliopancreatic diversion, and gastric banding. The overall mortality rate was nil in the early postoperative period and 5.3 % in the first postoperative year. The reoperation rate was 12.2 %. Obesity surgery seems feasible in this population, but mortality and morbidity are higher.
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Affiliation(s)
- Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
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Abstract
UNLABELLED Biliary complications (BCs) remain one of the most outstanding factors influencing long-term results after orthotopic liver transplantation. The authors carried out a systematic overview of 1720 papers since 2008, and focused on 45 relevant ones. Among 14,411 transplanted patients the incidence of BCs was 23%. Biliary leakage occurred in 8.5%, biliary stricture in 14.7%, mortality rate was 1-3%. RISK FACTORS preoperative sodium level; p = 0.037, model of end-stage liver disease score >25; p = 0.048, primary sclerosing cholangitis; p = 0.001, malignancy; p = 0.026, donor age >60, macrovesicular graft steatosis; p = 0.001, duct-to-duct anastomosis; p = 0.004, long anhepatic phase; p = 0.04, cold ischemic time >12 h; p = 0.043, use of T-tube; p = 0.032, insufficient flush of bile ducts; p = 0.001, acute rejection; p = 0.003, cytomegalovirus infection; p = 0.004 and hepatic artery thrombosis; p = 0.001. The management was surgical in case of biliary leakage, and interventional radiology or endoscopic retrograde cholangiopancreatography in case of biliary stricture. Mapping of miRNA profile is a new field of research. Nemes-Doros score is a useful tool in the estimation of hepatic artery thrombosis. Management of BCs requires a multidisciplinary expert team.
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Affiliation(s)
- Balázs Nemes
- Division of Transplantation, Institute of Surgery, Clinical Centre, University of Debrecen, Moricz Zs. krt. 22, Debrecen, H-4032, Hungary
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Mukund A, Rajesh S, Agrawal N, Arora A, Arora A. Percutaneous management of resistant biliary-enteric anastomotic strictures with the use of a combined cutting and conventional balloon cholangioplasty protocol: a single-center experience. J Vasc Interv Radiol 2015; 26:560-5. [PMID: 25666628 DOI: 10.1016/j.jvir.2014.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/20/2014] [Accepted: 12/09/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the safety and technical efficacy of percutaneous transhepatic dilation of resistant biliary-enteric anastomotic strictures using a combination of cutting and conventional balloons and evaluate midterm results. MATERIALS AND METHODS A retrospective review of patients with biliary-enteric anastomotic strictures treated with percutaneous transhepatic cutting balloon dilation was performed. Cutting balloon dilation was followed by dilation with the use of a conventional balloon with a diameter larger than that of the cutting balloon. Technical success was defined by the composite criteria of fluent passage of manually injected contrast medium through the anastomoses into the small bowel and absence of bile duct dilatation compared with the cholangiogram obtained before the procedure. Clinical and laboratory parameters, including serum bilirubin, alkaline phosphatase, and total leukocyte counts, were monitored in all patients at regular intervals after a technically successful procedure. RESULTS Between January 2012 and September 2013, eight patients (three men and five women) with a mean age of 50 years (range, 32-75 y) underwent 11 sessions of combined cutting and conventional balloon cholangioplasty. The procedure was technically successful in all patients. There were no major complications during the procedure. During the follow-up period (mean, 14 mo; range, 8-24 mo), all patients remained free of any biliary obstructive symptoms and had normal laboratory parameters with the absence of biliary dilatation on ultrasound examinations. CONCLUSIONS Cutting balloon dilation is a safe adjunctive option for the treatment of biliary-enteric anastomotic strictures resistant to conventional balloon dilation with acceptable midterm patency rates.
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Affiliation(s)
- Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India
| | - S Rajesh
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India.
| | - Nitesh Agrawal
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India
| | - Asit Arora
- Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India
| | - Ankur Arora
- Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India
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