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Background: Liver re-transplantation (re-LT) represents the only treatment for patients with irreversible graft failure. Objective: The aim of the current study was to describe the outcomes of both, patient and graft, after re- LT, at a high-volume referral center. Methods: Our population consisted of patients, with liver disease, who underwent re-LT in our institution between January 1996 and December 2019. Results: 49 patients met the inclusion criteria. The patient's overall survival (OS) for the first year was 85% (Confidence Intervals (CI) 71-92) and 70% at five years (CI 53-82). In our population, three (6.12%) patients presented loss of graft and were included again in the transplant list; of these, one agreed to a new transplant while the remaining two died. This gave us graft survival results similar to those obtained for the re-LT patient; 85% at one year (CI 71-92) and 70% at 5 years (CI 53-82). Conclusion: Our study shows that re-LT is a valid and safe treatment for both early graft dysfunction and for transplanted patients who again present end-stage liver disease, showing a satisfactory long-term evolution, with parameters comparable to primary transplantation.
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Haemorrhagic events in patients diagnosed with coronavirus disease 19 (COVID-19) are infrequent but reports have accumulated since the beginning of the pandemic. The pathophysiological mechanisms are unclear, but endothelial damage secondary to systemic vasculitis and the onset of anticoagulation therapy, both associated with severe forms of the infection, have been proposed to play a role in the development of this complication. We present the case of a 66-year-old man who presented to the emergency department with acute abdominal pain, hypotension and decrease of consciousness, a few hours after being discharged after a prolonged hospitalisation of 26 days due to severe SARS-CoV-2 pneumonia. Initial resuscitation was carried out and, when haemodynamic stabilisation was achieved, a computed tomography scan showed contrast extravasation at the topography of the greater omentum. Urgent angiography revealing contrast extravasation originating in a pseudoaneurysm dependent on the right gastroepiploic artery was done, and embolisation with cyanoacrylate was performed at the bleeding point. Owing to persistent haemodynamic instability despite angiographic treatment and aggressive resuscitation, emergency laparotomy was indicated. Partial resection of the greater omentum was carried out and histopathologic examination showed a 5cm×4cm×6cm haematoma, with no signs of abnormalities such as aneurysm or malignancy. No rebleeding occurred. Spontaneous haemorrhage of the greater omentum associated with haemoperitoneum is a serious condition, with reported mortality rates exceeding 30%. This case highlights a very infrequent but potentially life-threatening complication in a patient diagnosed with COVID-19 on anticoagulation therapy.
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COVID-19/complicações , Hemoperitônio/etiologia , Hemorragia/virologia , Omento/cirurgia , Doenças Peritoneais/virologia , Idoso , Hemoperitônio/cirurgia , Hemorragia/cirurgia , Humanos , Masculino , Doenças Peritoneais/cirurgiaRESUMO
BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
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Laparoscopia , Neoplasias Hepáticas , Argentina , Ásia , Brasil , Chile , Colômbia , Europa (Continente) , Hepatectomia , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , PeruAssuntos
Ampola Hepatopancreática/patologia , Neoplasias Duodenais/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neurofibromatose 1/complicações , Ductos Pancreáticos/patologia , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias Duodenais/patologia , Neoplasias Duodenais/fisiopatologia , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/fisiopatologia , Tumores Neuroendócrinos/cirurgia , Pancreaticoduodenectomia , Resultado do TratamentoRESUMO
BACKGROUND: The role of intraoperative cholangiography (IOC) in the diagnosis, prevention and management of bile duct injury (BDI) remains controversial. The aim of the present study was to determine the value of routine IOC in the diagnosis and management of BDI sustained during laparoscopic cholecystectomy (LC) at a high-volume centre. METHODS: A retrospective analysis of a single-institution database was performed. Patients who underwent LC with routine IOC between October 1991 and May 2012 were included. RESULTS: Among 11,423 consecutive LCs IOC was performed successfully in 95.7 per cent of patients. No patient had IOC-related complications. Twenty patients (0.17 per cent) sustained a BDI during LC, and the diagnosis was made during surgery in 18 patients. Most BDIs were type D according to the Strasberg classification. The sensitivity of IOC for the detection of BDI was 79 per cent; specificity was 100 per cent. All injuries diagnosed during surgery were repaired during the same surgical procedure. Two patients developed early biliary strictures that were treated by percutaneous dilatation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results. CONCLUSION: The routine use of IOC during LC in a high-volume teaching centre was associated with a low incidence of BDI, and facilitated detection and repair during the same surgical procedure with a good outcome.
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Ductos Biliares/lesões , Colangiografia/métodos , Colecistectomia Laparoscópica/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Laparoscopic cholecystectomy is the present treatment of choice for patients with gallbladder stones, despite its being associated with a higher incidence of biliary injuries compared with the open procedure. Injuries occurring during the laparoscopic approach seem to be more complex. A complex biliary injury is a disease that is difficult to diagnose and treat. We considered complex injuries: 1) injuries that involve the confluence; 2) injuries in which repair attempts have failed; 3) any bile duct injury associated with a vascular injury; 4) or any biliary injury in association with portal hypertension or secondary biliary cirrhosis. The present review is an evaluation of our experience in the treatment of these complex biliary injuries and an analysis of the international literature on the management of patients.
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BACKGROUND AND AIM: Resection of colorectal liver metastases has become a standard of care, although the value of this procedure in non-colorectal non-neuroendocrine (NCRNNE) metastases remains controversial and is still a matter of debate. The aim of the study was to determine the utility of liver resection in the long-term outcome of patients with NCRNNE metastases. MATERIAL AND METHODS: The records of 106 patients who underwent liver resection for NCRNNE metastases in the period 1989 to 2006 at 5 HPB Centers in Argentina were analyzed. Patient demographics, tumor characteristics, type of resection, long-term outcome and prognostic factors were analyzed. Depending on primary tumor sites, a comparative analysis of survival was performed. RESULTS: Mean age was 54 (17-76). Hepatic metastases were solitary in 62.3% and unilateral in 85.6%. Primary tumor sites: Urogenital (37.7%), sarcomas (21.7%), breast (17.9%), gastrointestinal (6.6%), melanoma (5.7%), and others (10.4%). Fifty-one major hepatectomies and 55 minor resections were performed. Twenty patients underwent synchronous resections. An R0 resection could be achieved in 89.6%. Perioperative mortality was 1.8%. Overall, 1-year, 3-year, and 5-year survival rates were 67%, 34%, and 19%, respectively. Survival was significantly longer for metastases of urogenital (p=0.0001) and breast (p=0.003) origin. Curative resections (p=0.04) and metachronous disease (p=0.0001) were predictors of better survival. CONCLUSIONS: Liver resection is an effective treatment for NCRNNE liver metastases; it gives satisfactory long-term survival especially in metachronous disease, in patients with metastases from urogenital and breast tumors and when R0 procedures can be performed.
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BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. In the current study, this approach was associated with a higher incidence of biliary injuries. The authors evaluate their experience treating complex biliary injuries and analyze the literature. METHODS: In a 15-year period, 169 patients with bile duct injuries (BDIs) resulting from open and laparoscopic cholecystectomies were treated. The patients were retrospectively evaluated through their records. Biliary injury and associated lesions were evaluated with imaging studies. Surgical management included therapeutic endoscopy, percutaneous interventions, hepaticojejunostomy, liver resection, and liver transplantation. Postoperative outcome was recorded. Survival analysis was performed with G-Stat and NCSS programs using the Kaplan-Meier method. RESULTS: Of the 169 patients treated for BDIs, 148 were referred from other centers. The injuries included 115 lesions resulting from open cholecystectomy and 54 lesions resulting from laparoscopic cholecystectomy. A total of 110 patients (65%) fulfilled the criteria for complex injuries, 11 of whom met more than one criteria. Injuries resulting from laparoscopic and open cholecystectomies were complex in 87.5% and 72% of the patients, respectively. The procedures used were percutaneous transhepatic biliary drainage for 30 patients, hepaticojejunostomy for 96 patients, rehepaticojejunostomy for 16 patients, hepatic resection for 9 patients, and liver transplantation projected for 18 patients. Hepaticojejunostomy was effective for 85% of the patients. The mean follow-up period was 77.8 months (range, 4-168 months). The mortality rate for noncomplex BDI was 0%, as compared with the mortality rate of 7.2% (8/110) for complex BDI. Mortality after hepatic resection was nil, and morbidity was 33.3%. The actuarial survival rate for liver transplantation at 1 year was 91.7%. CONCLUSIONS: Complex BDIs after laparoscopic cholecystectomy are potentially life-threatening complications. In this study, late complications of complex BDIs appeared when there was a delay in referral or the patient received multiple procedures. On occasion, hepatic resections and liver transplantation proved to be the only definitive treatments with good long-term outcomes and quality of life.
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Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Adolescente , Adulto , Idoso , Doenças dos Ductos Biliares/etiologia , Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Criança , Colecistectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de TempoRESUMO
Antecedentes: El trasplante hepático es el tratamiento de elección para pacientes con enfermedad hepática terminal. La disponibilidad de órganos es el factor limitante para su empleo. El empleo de injertos provenientes de donantes vivos desde hace años se aplica a la población pediátrica y en los últimos años se ha generalizado su uso en receptores adultos. Objetivo: Analizar la experiencia con el empleo de esta técnica en nuestro programa de trasplante. Lugar de aplicación: Hospital Privado de la comunidad. Diseño: Estudio retrospectivo y descriptivo. Población: 458 pacientes a los que se le realizaron 492 trasplantes hepáticos ortotópicos (TOH). 79 (TOH) con donante vivo (50 niños y 29 adultos). Método: Se realizó la evaluación de los donantes con exámenes de laboratorio. Ecodoppler y tac abdominal, posteriormente arteriografía y biopsia hepática en caso de sospechar hepatopatía. Los niños fueron trasplantados con segmentos II y III (n = 45) o con monosegmento (n = 5). 28 adultos recibieron hígado derecho (LD) y uno hígado izquierdo (LI). Resultados: De 120 potenciales donantes pediátricos 60 fueron rechazados (50 por ciento). Presentaron complicaciones 6 de los 50 (12 por ciento). Se evaluaron 71 potenciales donantes para adultos, fueron rechazados 25 (35,2 por ciento). Cinco de los 29 (17,2 por ciento) donantes presentaron complicaciones. La indicación más frecuente fue la atresia de vías biliares en la población pediátrica (65,9 por ciento) y cirrosis por Virus C en los adultos (44 por ciento). Las complicaciones vasculares en la población pediátrica ocurrieron en 8 pacientes (16 por ciento) y las biliares en 14 (28 por ciento). La supervivencia actuarial de pacientes e injertos a 10 años fue de 94 por ciento y 90 por ciento respectivamente. Los adultos presentaron complicaciones vasculares en el 6,89 por ciento y biliares en el 37 por ciento. La supervivencia actuarial de pacientes e injertos fue de 89,8 por ciento y 89,3 por ciento al año y de 83,7 por...
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Humanos , Masculino , Feminino , Lactente , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Pré-Escolar , Doadores Vivos , Transplante de Fígado/métodos , Argentina , Estudos Retrospectivos , Transplante de Fígado/estatística & dados numéricos , Transplante de Fígado/normasRESUMO
Antecedentes: Las fístulas biliares son una rara complicación de la patología biliar (1 por ciento al 2 por ciento). Las controversias se plantean en la estrategia y en el abordaje quirúrgico. Objetivo: Evaluar la utilidad y resultados alejados del abordaje laparoscópico en el tratamiento de las fístulas biliares internas y del síndrome de Mirizzi tipo II. Lugar de aplicación: Hospital privado de la comunidad. Diseño: Estudio retrospectivo y descriptivo. Población: Se evaluó en forma retrospectiva los pacientes con diagnóstico de fístula biliar entre noviembre de 1991 y diciembre de 2004 excluyéndose aquellos pacientes con origen neoplásico de la fístula. Método: De 6108 colecistectomías videolaparoscóoicas, se diagnosticó fístula biliar interna en 38 pacientes (0,62 por ciento). Sexo femenino 28 (75,6 por ciento). Se trataron de 21 fístulas colecistoduodenales, 12 colecistocoledocianas (Mirizzi Tipo II), 4 colecistocolónicas y una fístula colecistoduodenal y colecistocoledociana asociada. Resultados: La estadía hospitalaria de 4,8 días (r: 2-11). Tiempo operatorio promedio: 183 minutos (r: 110-300). Se realizó colangiografía en el 100 por ciento de los pacientes. Morbilñidad en 8 pacientes (21,05 por ciento). Un paciente presentó una lesión quirúrgica de la vía bibliar que fue advertida y reparada en el intraoperatorio mediante una hepaticoyeyuno anastomosis. No hubo reoperaciones y un paciente falleció por una neumonía intrahospitalaria. Conversión en 7 pacientes (18,4 por ciento). En el seguimiento alejado un paciente presentó litiasis residual resuelta mediante CPRE y dos pacientes presentaron ca. de vesícula. Conclusiones: Las fístulas biliares internas son infrecuentes. El abordaje videolaparoscópico ofrece las ventajas de un procedimiento mini-invasivo, con buenos resultados alejados. Su utilidad es factible con un entrenamiento adecuado