HPB surgery : a world journal of hepatic, pancreatic and biliary surgery最新文献

{"title":"Ischemia/Reperfusion injury in liver surgery and transplantation.","authors":"Peter Schemmer, John J Lemasters, Pierre-Alain Clavien","doi":"10.1155/2012/453295","DOIUrl":"https://doi.org/10.1155/2012/453295","url":null,"abstract":"Despite medical advances, there is unfortunately still no guarantee for adequate liver function after extended resection and transplantation. Impaired liver function is associated with high morbidity and mortality. While the underlying mechanisms are only partly understood, they seem to have similar pathophysiological pathways. \u0000 \u0000Ischemia/reperfusion injury (IRI) is one of the main contributors to decreased liver function after liver surgery. Posthepatectomy failure is reported in up to 60–90% of cases, despite the fact that the liver remnant's volume in itself should be sufficient to maintain adequate function. After liver transplantation (LT), IRI cannot be avoided and is one of the ultimate factors that limits liver function after LT. Taking into account the various definitions of primary dysfunction and primary nonfunction as well as the number of grafts with high risk of failure and other risk factors, poor graft function is reported in up to 88% of patients after LT. While techniques that do not require hepatic vascular occlusion for liver resection (LR) have evolved, inevitable surgical manipulation itself creates hypoxia to liver tissue during LR, donor hepatectomy, and LT. \u0000 \u0000Organ specific parameters, such as preexisting damage (i.e., steatosis/steatohepatitis), and additional liver injury, such as surgical trauma, perfusion/preservation solutions, cold/warm ischemia time, and reperfusion, have been identified as contributing towards IRI. \u0000 \u0000Although some risk factors for mortality and morbidity after hepatic surgery including LT are defined, little is known about the mechanisms of injury. To date, no valid clinical concepts to preserve hepatic integrity and guarantee adequate regeneration in the context of both LT and LR have evolved. Indeed, many protective strategies have been proposed with the aim of preemptively inducing tolerance against IRI or interfering with the pathways of injury and regeneration—either by inhibiting deleterious molecules or enhancing protective pathways. Thus, the focus of this special issue of HPB surgery is on donor preconditioning, warm ischemia, nonheart-beating donors, hemorrhage and resuscitation-related liver injury, antioxidants, liver resection and transplantation, hepatic microperfusion, anesthetic considerations, and small-for-size phenomena. \u0000 \u0000 \u0000Peter Schemmer \u0000 \u0000John J. Lemasters \u0000 \u0000Pierre-Alain Clavien","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"453295"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/453295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31183381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"About usefulness of kalemia monitoring after blunt liver trauma.","authors":"Francesco Meriggi,&nbsp;Paolo Gramigna,&nbsp;Paola Tramelli","doi":"10.1155/2012/279708","DOIUrl":"https://doi.org/10.1155/2012/279708","url":null,"abstract":"<p><p>Background. The aim of this study is to investigate the evidence of hypokalemia as a suitable parameter for therapeutic decision making after severe blunt liver trauma. Methods. We reviewed the medical records of 11 patients (9 M, 2 F, mean age 32 years) admitted to San Matteo Hospital of Pavia between 2007-2009. All of them were victims of road accidents hospitalized for blunt liver injury and submitted to surgery. Results. Hypokalemia was observed in 7/11 (63.6%) patients during the preoperative period (mean value 2.91 mEq/L). Serum potassium concentration normalized in all patients at the 7th postoperative day only (P < 0.01). Conclusions. According to literature results, our study confirms that after blunt hepatic injury serum potassium levels may decrease significantly. Therefore, kalemia must be carefully monitored in order to establish appropriate treatment and avoid any complications.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":" ","pages":"279708"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/279708","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experiences of simultaneous laparoscopic resection of colorectal cancer and liver metastases.","authors":"L T Hoekstra,&nbsp;O R C Busch,&nbsp;W A Bemelman,&nbsp;T M van Gulik,&nbsp;P J Tanis","doi":"10.1155/2012/893956","DOIUrl":"https://doi.org/10.1155/2012/893956","url":null,"abstract":"<p><p>Introduction. Simultaneous resection of primary colorectal carcinoma (CRC) and synchronous liver metastases (SLMs) is subject of debate with respect to morbidity in comparison to staged resection. The aim of this study was to evaluate our initial experience with this approach. Methods. Five patients with primary CRC and a clinical diagnosis of SLM underwent combined laparoscopic colorectal and liver surgery. Patient and tumor characteristics, operative variables, and postoperative outcomes were evaluated retrospectively. Results. The primary tumor was located in the colon in two patients and in the rectum in three patients. The SLM was solitary in four patients and multiple in the remaining patient. Surgical approach was total laparoscopic (2 patients) or hand-assisted laparoscopic (3 patients). The midline umbilical or transverse suprapubic incision created for the hand port and/or extraction of the specimen varied between 5 and 10 cm. Median operation time was 303 (range 151-384) minutes with a total blood loss of 700 (range 200-850) mL. Postoperative hospital stay was 5, 5, 9, 14, and 30 days. An R0 resection was achieved in all patients. Conclusions. From this initial single-center experience, simultaneous laparoscopic colorectal and liver resection appears to be feasible in selected patients with CRC and SLM, with satisfying short-term results.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"893956"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/893956","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30988674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neither MICA Nor DEPDC5 Genetic Polymorphisms Correlate with Hepatocellular Carcinoma Recurrence following Hepatectomy.","authors":"Takashi Motomura, Yuki Ono, Ken Shirabe, Takasuke Fukuhara, Hideyuki Konishi, Yohei Mano, Takeo Toshima, Shohei Yoshiya, Jun Muto, Toru Ikegami, Tomoharu Yoshizumi, Yoshihiko Maehara","doi":"10.1155/2012/185496","DOIUrl":"10.1155/2012/185496","url":null,"abstract":"<p><p>Purpose. Genetic polymorphisms of MICA and DEPDC5 have been reported to correlate with progression to hepatocellular carcinoma (HCC) in chronic hepatitis C patients. However, correlation of these genetic variants with HCC recurrence following hepatectomy has not yet been clarified. Methods. Ninety-six consecutive HCC patients who underwent hepatectomy, including 64 patients who were hepatitis C virus (HCV) positive, were genotyped for MICA (rs2596542) and DEPDC5 (rs1012068). Recurrence-free survival rates (RFS) were compared for each genotype. Results. Five-year HCC recurrence-free survival (RFS) rates following hepatectomy were 20.7% in MICA GG allele carriers, 38.7% in GA, and 20.8% in AA, respectively (P = 0.72). The five-year RFS rate was 23.8% in DEPDC5 TT allele carriers and 31.8% in TG/GG, respectively (P = 0.47). The survival rates in all (including HCV-negative) patients were also similar among each MICA and DEPDC5 genotype following hepatectomy. Among HCV-positive patients carrying the DEPDC5 TG/GG allele, low fibrosis stage (F0-2) occurred more often compared with TT carriers (P < 0.05). Conclusions. Neither MICA nor DEPDC5 genetic polymorphism correlates with HCC recurrence following hepatectomy. DEPDC5 minor genotype data suggest a high susceptibility for HCC development in livers, even those with low fibrosis stages.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"185496"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31030653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The underlying mechanisms: how hypothyroidism affects the formation of common bile duct stones-a review.","authors":"Johanna Laukkarinen,&nbsp;Juhani Sand,&nbsp;Isto Nordback","doi":"10.1155/2012/102825","DOIUrl":"https://doi.org/10.1155/2012/102825","url":null,"abstract":"<p><p>For decades, one well-known risk factor for the development of gallbladder stones has been hypothyroidism. Recent studies have interestingly reported that the risk in particular for common bile duct (CBD) stones increases in clinical and subclinical hypothyroidism. There are multiple factors that may contribute to the formation and/or accumulation of CBD stones in hypothyroid patients, including decreased liver cholesterol metabolism, diminished bile secretion, and reduced sphincter of Oddi relaxation. This paper focuses on the mechanisms possibly underlying the association between hypothyroidism and CBD stones. The authors conclude that when treating patients with CBD stones or microlithiasis, clinicians should be aware of the possible hypothyroid background.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"102825"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/102825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30965110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatocellular adenoma: evaluation with contrast-enhanced ultrasound and MRI and correlation with pathologic and phenotypic classification in 26 lesions.","authors":"Anne-Frédérique Manichon,&nbsp;Brigitte Bancel,&nbsp;Marion Durieux-Millon,&nbsp;Christian Ducerf,&nbsp;Jean-Yves Mabrut,&nbsp;Marie-Annick Lepogam,&nbsp;Agnès Rode","doi":"10.1155/2012/418745","DOIUrl":"https://doi.org/10.1155/2012/418745","url":null,"abstract":"<p><p>Purpose. To review the contrast-enhanced ultrasonographic (CEUS) and magnetic resonance (MR) imaging findings in 25 patients with 26 hepatocellular adenomas (HCAs) and to compare imaging features with histopathologic results from resected specimen considering the new immunophenotypical classification. Material and Methods. Two abdominal radiologists reviewed retrospectively CEUS cineloops and MR images in 26 HCA. All pathological specimens were reviewed and classified into four subgroups (steatotic or HNF 1α mutated, inflammatory, atypical or β-catenin mutated, and unspecified). Inflammatory infiltrates were scored, steatosis, and telangiectasia semiquantitatively evaluated. Results. CEUS and MRI features are well correlated: among the 16 inflammatory HCA, 7/16 presented typical imaging features: hypersignal T2, strong arterial enhancement with a centripetal filling, persistent on delayed phase. 6 HCA were classified as steatotic with typical imaging features: a drop out signal, slight arterial enhancement, vanishing on late phase. Four HCA were classified as atypical with an HCC developed in one. Five lesions displayed important steatosis (>50%) without belonging to the HNF1α group. Conclusion. In half cases, inflammatory HCA have specific imaging features well correlated with the amount of telangiectasia and inflammatory infiltrates. An HCA with important amount of steatosis noticed on chemical shift images does not always belong to the HNF1α group.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"418745"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/418745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30774088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic control after total pancreatectomy for intraductal papillary mucinous neoplasm: an exploratory study.","authors":"Laith H Jamil,&nbsp;Ana M Chindris,&nbsp;Kanwar R S Gill,&nbsp;Daniela Scimeca,&nbsp;John A Stauffer,&nbsp;Michael G Heckman,&nbsp;Shon E Meek,&nbsp;Justin H Nguyen,&nbsp;Horacio J Asbun,&nbsp;Massimo Raimondo,&nbsp;Timothy A Woodward,&nbsp;Michael B Wallace","doi":"10.1155/2012/381328","DOIUrl":"https://doi.org/10.1155/2012/381328","url":null,"abstract":"<p><p>Background. Glycemic control following total pancreatectomy (TP) has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN) is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM). Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C) at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, P = 0.52), 12 months (7.3% versus 8.0%, P = 0.081), 18 months (7.7% and 7.6%, P = 0.64), and at 24 months (7.3% versus 7.8%, P = 0.10)). Seven TP patients (50%) experienced a hypoglycemic event compared to 65 type 1 DM patients (65%, P = 0.38). Limitations. Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"381328"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/381328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30895565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are pyogenic liver abscesses still a surgical concern? A Western experience.","authors":"Barbara Alkofer,&nbsp;Corentin Dufay,&nbsp;Jean Jacques Parienti,&nbsp;Vincent Lepennec,&nbsp;Sylvie Dargere,&nbsp;Laurence Chiche","doi":"10.1155/2012/316013","DOIUrl":"https://doi.org/10.1155/2012/316013","url":null,"abstract":"<p><p>Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6 g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess (P = 0.006) and septic shock at the initial presentation (P = 0.008). Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":" ","pages":"316013"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/316013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experience in single-incision transumbilical laparoscopic liver resection: indications, potential benefits, and limitations.","authors":"Giovanni Dapri,&nbsp;Livia Dimarco,&nbsp;Guy-Bernard Cadière,&nbsp;Vincent Donckier","doi":"10.1155/2012/921973","DOIUrl":"https://doi.org/10.1155/2012/921973","url":null,"abstract":"<p><p>Background. Single-incision transumbilical laparoscopic liver resection (SITLLR) has been recently described in limited series. We report our experience in SITLLR and discuss the future of this approach in terms of indications, potential benefits, and limitations, with a special reference to laparoscopic liver resection (LLR). Patients and Methods. Six patients underwent SITLLR. Indications were biliary cysts (3 cases), hydatid cysts (2), and colorectal liver metastasis (1). Procedures consisted in cysts unroofing, left lateral lobectomy, pericystectomy, and wedge resection. SITLLR was performed with 11 mm reusable trocar, 10 or 5 mm 30° scopes, 10 mm ultrasound probe, curved reusable instruments, and straight disposable bipolar shears. Results. Neither conversion to open surgery nor insertion of supplementary trocars was necessary. Median laparoscopic time was 105.5 minutes and median blood loss 275 mL. Median final umbilical scar length was 1.5 cm, and median length of stay was 4 days. No early or late complications occurred. Conclusion. SITLLR remains a challenging procedure. It is feasible in highly selected patients, requiring experience in hepatobiliary and laparoscopic surgery and skills in single-incision laparoscopy. Apart from cosmetic benefit, our experience and literature review did not show significant advantages if compared with multiport LLR, underlying that specific indications remain to be established.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"921973"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/921973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30988675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bile duct leaks from the intrahepatic biliary tree: a review of its etiology, incidence, and management.","authors":"Sorabh Kapoor,&nbsp;Samiran Nundy","doi":"10.1155/2012/752932","DOIUrl":"https://doi.org/10.1155/2012/752932","url":null,"abstract":"<p><p>Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.</p>","PeriodicalId":77165,"journal":{"name":"HPB surgery : a world journal of hepatic, pancreatic and biliary surgery","volume":"2012 ","pages":"752932"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/752932","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30653109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}