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Lazzarotto-da-Silva G, Santos LM, Lucena IRS, Rabolini BB, Hallal CP, Feier FH, Grezzana-Filho TJM, Chedid MF, Leipnitz I, Chedid AD, de Araujo A, Alvares-da-Silva MR, Kruel CRP. Celiac trunk stenosis by median arcuate ligament in orthotopic liver transplantation: a potential hidden foe to the biliary tree. HPB (Oxford) 2024; 26:137-144. [PMID: 37722997 DOI: 10.1016/j.hpb.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Celiac trunk compression by the median arcuate ligament (MAL) increases the risk of ischemic complications following gastrointestinal surgical procedures. Previous studies suggest increased risk of hepatic artery thrombosis (HAT) in orthotopic liver transplant (OLT) recipients. The aim of this study is to investigate the impact of untreated MAL compression (MAL-C) on biliary complications in OLT. METHODS Contrast-enhanced imaging was used to classify celiac trunk stenosis by MAL-C. Medical records were reviewed to extract pre-transplant, transplant and post-transplant data. Patients were divided into two groups: no MAL compression (nMAL-C) and MAL-C. The primary endpoint was biliary complications. Secondary endpoints were HAT and graft survival. RESULTS 305 OLT were performed from 2010 to 2021, of which 219 were included for analysis: 185 (84.5%) patients without and 34 (15.5%) with MAL-C. The incidence of HAT was 5.9% in both groups. Biliary complications were more common in the MAL-C group (35.3% vs. 17.8%, p = 0.035). Graft survival was decreased in patients with MAL-C (p = 0.035). CONCLUSIONS MAL-C of the celiac trunk was associated with increased risk of biliary complications and inferior graft survival in OLT patients. These findings highlight the importance of preoperative screening and treatment of MAL in this population.
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Affiliation(s)
| | | | - Iara R S Lucena
- Radiology Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Bruno B Rabolini
- Post-Graduate Program in Surgical Sciences, Medical School of UFRGS, Brazil
| | - Celina P Hallal
- Post-Graduate Program in Surgical Sciences, Medical School of UFRGS, Brazil
| | - Flavia H Feier
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Marcio F Chedid
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Ian Leipnitz
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Aljamir D Chedid
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | - Alexandre de Araujo
- Gastroenterology and Hepatology Unit, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Cleber R P Kruel
- Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Brazil
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Piltcher-da-Silva R, Soares PS, Hutten DO, Schnnor CC, Valandro IG, Rabolini BB, Medeiros BM, Duarte RG, Volkweis BS, Grudtner MA, Cavazzola LT. Incisional Hernias after Vascular Surgery for Aortoiliac Aneurysm and Aortoiliac Occlusive Arterial Disease: Has Prophylactic Mesh Changed This Scenario? Aorta (Stamford) 2023; 11:107-111. [PMID: 37619567 PMCID: PMC10449565 DOI: 10.1055/s-0043-1771475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/07/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Incisional hernia (IH) is an important surgical complication that has several ways of prevention, including modifications in the surgical technique of the initial procedure. Its incidence can reach 69% in high-risk patients and long-term follow-up. Of the risky procedures, open abdominal aortic aneurysmectomy is the one with the highest risk. Ways to reduce this morbid complication were suggested, and prophylactic mesh rises as an important tool to prevent recurrence. METHODS A retrospective cohort study review of medical records of patients undergoing vascular surgery for abdominal aortoiliac aneurysm (AAA) or vascular bypass surgery due to aortoiliac occlusive disease. We identified 193 patients treated between 2010 and 2020. We further performed a one-to-nine matching analysis between the use of prophylactic mesh and control groups, based on estimated propensity scores for each patient. RESULTS Prophylactic mesh group had a 18% lower risk of IH, compared with the control group (relative risk: 0.82; 95% confidence interval [CI] = 0.74-0.93). The difference in IH rates between the groups compared was 2.6% (95% CI: -19.8 to 25.5). From the perspective of the number needed to treat, it would be necessary to use prophylactic mesh in 39 (95% CI: 35-44) patients to avoid one IH in this population. CONCLUSION Use of prophylactic mesh in the repair of AAA significantly reduces the incidence of IH in nearly one in five cases. Our data suggest that there is benefit in the use of prophylactic mesh in open aneurysmectomy surgery regarding postoperative IH development.
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Affiliation(s)
- Rodrigo Piltcher-da-Silva
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
- Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil
| | - Pedro S.M. Soares
- Postgraduate Epidemiology Department, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Debora O. Hutten
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
| | - Cláudia C. Schnnor
- Vascular Surgery Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Isabelle G. Valandro
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
| | - Bruno B. Rabolini
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
| | - Brenda M. Medeiros
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
| | - Rafaela G. Duarte
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
| | - Bernardo S. Volkweis
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
| | - Marco A. Grudtner
- Vascular Surgery Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leandro T. Cavazzola
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre Rio Grande do Sul, Brazil
- Postgraduate Program in Medicine: Surgical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil
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