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Primary hilar techniques for isolation of the glissonian pedicles in major an minor liver resections

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The document discusses different approaches and techniques for liver resection surgery. It describes the posterior approach through the dorsal fissure between liver segments as a transfissural technique that allows visualization and dissection of the Glissonian pedicle sheaths. This approach has technical advantages for right hepatectomies, extended right or left hepatectomies, and right segmentectomies. It also has oncological benefits for resection of tumors like Klatskin tumors, primary and secondary liver cancers by enabling clear margins.

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- Liver resection (LR) and liver transplantation (LTx) are two treatment options for hepatocellular carcinoma (HCC). This study compares outcomes of 282 patients receiving LR and 187 receiving LTx. - Patients who received LTx had a higher perioperative mortality rate compared to LR patients (18.1% vs 4.5%), mainly due to sepsis, multiple organ failure, and vascular complications. Late mortality was higher in LR patients and mainly due to tumor recurrence. - Recurrence rates were significantly higher after LR (47.4% vs 9%), and survival after recurrence was also lower with LR. Factors associated with recurrence and survival included tumor characteristics such as α-fetoprotein levels,

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TIPSS is a procedure that creates a permanent connection between the portal and hepatic veins to reduce portal hypertension. It has several indications including uncontrolled variceal bleeding and refractory ascites. The procedure involves catheterization of the jugular vein and placement of a stent. Complications can include thrombosis, hemorrhage, and encephalopathy. Success rates are over 80% for variceal bleeding and 50% for ascites, but secondary dysfunction occurs in 40% after 1 year often requiring revision. TIPSS provides immediate reduction in portal pressure and is less invasive than surgical shunting.

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The document discusses the proximal splenorenal shunt procedure for patients with liver cirrhosis and portal hypertension combined with hypersplenism. The procedure involves creating a shunt from the splenic vein to the left renal vein to decompress the portal system. It is indicated for select patients as an alternative to other procedures to prevent variceal bleeding while removing the spleen. However, it carries risks of hepatic encephalopathy, worsening liver function, and is not suitable for future transplantation. The authors' experience with 17 patients who underwent this procedure is presented, along with postoperative outcomes.

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The document describes a right trisegmentectomy procedure using the Launois approach to remove segments IV, V, and VIII of the liver. It indicates that this extensive resection removes around 70-85% of the liver's functional tissue. The procedure involves ligating the right portal vein and dissecting along the ligament of the inferior vena cava before removing the specified segments. Post-operative imaging showed regeneration of the remaining left lateral section of the liver.

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1. The document discusses the history and mechanisms of radiofrequency ablation (RFA) for treating hepatic tumors. RFA uses alternating current within 200-1200 MHz to generate heat and coagulate tissue. 2. RFA can be performed percutaneously, laparoscopically, or during open surgery. Different ablation schemes and needle types are used depending on tumor size and location. 3. Complications of RFA include wound infection, bleeding, and abscesses. Studies show high rates of initial tumor necrosis but frequent recurrence within a year.

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The document discusses various treatment options for portal hypertension and its complications. It covers surgical procedures like devascularization operations, portosystemic shunts and splenorenal shunts that are aimed at preventing bleeding, stopping active bleeding, and preventing recurrent variceal bleeding. The choice of surgical treatment depends on factors like the severity of bleeding, liver dysfunction, and type of portal hypertension.

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The document discusses segment oriented liver resections. It describes how improved imaging and surgical techniques have enabled more precise resections based on the liver's segmental anatomy. Various types of segmental resections are outlined, including segmentectomies, bisegmentectomies, and trisegmentectomies. Indications for these procedures include benign lesions, cirrhosis, multiple lesions, and liver metastases. Postoperative morbidity and mortality rates are reported to be minimal.

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1) The surgical treatment of portal hypertension has evolved significantly in Egypt over the last century, driven by changes in liver pathology and the development of new techniques. 2) Initially, procedures like splenectomy were used but caused only temporary effects. Total portosystemic shunts were then introduced but were later abandoned due to high mortality and morbidity rates. 3) More selective surgeries and techniques were developed like Hassab's operation and mesocaval shunts but still had issues. The distal splenorenal shunt became more widely used as a selective shunt.

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More from fundeni (13)

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This document discusses endoscopic therapies for the management of variceal hemorrhage, specifically endoscopic sclerotherapy (EST) and endoscopic variceal ligation (EVL). It provides background on variceal bleeding and survival rates over time. It then describes the modalities and techniques of EST and EVL, including injection methods, sclerosing agents used, risks, and indications. Randomized controlled trials comparing EST and EVL are summarized, showing higher eradication rates with EVL. In conclusion, endoscopic therapies like EST and EVL are effective for controlling acute variceal bleeding and reducing recurrence when used for primary or secondary prophylaxis.

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This document discusses chemotherapy options for biliary tree carcinoma. It begins by outlining the increasing mortality rates and poor prognosis of the disease. It then provides detailed information on the anatomical classification, histological classification, definition, risk factors, and problems associated with diagnosis and treatment. The document discusses surgery as the only potentially curative option but notes that most patients present with advanced, unresectable disease. It reviews several palliative chemotherapy regimens and their response rates and survival benefits, with various gemcitabine-based combinations showing the most promise. The challenges of treating this rare cancer are also summarized.

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This document summarizes a study comparing outcomes of surgical treatment for intrahepatic cholangiocarcinoma (ICC) and hilar cholangiocarcinoma (Klatskin tumor). 59 patients who underwent liver resection for these tumors were analyzed. Klatskin tumors required more extensive resections and had higher postoperative morbidity. 5-year survival was similar for both tumor types at around 35%. Expression of the p27 protein was associated with lower recurrence rates and better survival outcomes. Surgical resection remains the primary treatment when possible but molecular markers may help guide future adjuvant therapies.

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The document discusses different surgical treatments for portal hypertension between 1877-2003. It lists various types of shunt procedures that were developed over time to reduce portal pressure, including Eck-Pavlov-Vidal shunt in 1967, Warren shunt in 1967, and Starzl auxiliary liver transplantation in 1973. The document also discusses surgical treatments for Budd-Chiari syndrome and ascites, such as portocaval shunts, mesenterico-caval shunts, and LeVeen shunts. It concludes by providing data on the types of shunt procedures performed between 1997-2003 for portal hypertension treatment and their results.

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The document discusses guidelines for evaluating and treating hepatic metastases from colorectal cancer. It recommends investigations like CT, MRI, and ultrasound to evaluate metastases. Metastases are considered immediately resectable if the surgery is technically possible and leaves at least 40% of liver volume. Resection may be possible but risky if it requires complex procedures. Factors like number, size and location of metastases impact prognosis but are not absolute contraindications to resection. Repeat resection of recurrent metastases can provide long-term survival.

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This document discusses the management of cholangiocarcinoma based on the author's experience at the Mansoura University Gastroenterology Surgical Center in Egypt. Some key points include: - Cholangiocarcinoma is the second most common malignant liver tumor after hepatocellular carcinoma. - Surgical resection remains the main treatment when possible but many cases are unresectable due to advanced stage at presentation. - Of 385 patients treated between 1995-2002, 216 had central cholangiocarcinoma and most (79%) of these were unresectable. - For unresectable cases, various palliative treatments were used with a mean survival of 5.8

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This document discusses liver transplantation for hepatitis C virus (HCV) disease. It outlines that HCV reinfection is common after transplantation, occurring in 87-97% of cases. There are different patterns of HCV recurrence post-transplant, including minimal liver injury, chronic HCV, and cholestatic HCV. Factors associated with increased rates of fibrosis post-transplant include older recipient age, bolus steroid use for rejection, induction with mycophenolic acid, and short duration of prednisone use. High pre-transplant HCV RNA levels are also associated with worse patient and graft survival outcomes.

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1. Antiviral therapy both before and after liver transplantation is important to prevent recurrent infection of the graft by hepatitis B and C viruses. 2. Combination therapy with hepatitis B immune globulin and antiviral drugs like lamivudine is effective at preventing HBV recurrence in most patients. 3. Recurrence of HCV infection after transplantation is very common, but antiviral treatment with interferon or pegylated interferon plus ribavirin can achieve sustained virologic response in some patients and prevent progression of liver disease.

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The document summarizes studies on using radioactive iodine-labeled lipiodol (131I lipiodol) as a neoadjuvant treatment for hepatocellular carcinoma (HCC) prior to liver resection or transplantation. It found that 131I lipiodol allowed resection of larger HCC tumors (>3cm) with 3-year survival of 42%. For liver transplantation, 131I lipiodol prior to the procedure led to 5-year survival of 77% for HCC of all sizes, compared to 18% without neoadjuvant treatment, and no patients who received 131I lipiodol experienced HCC recurrence.

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Liver transplantation

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The document describes a new technique using radiofrequency (RF) energy for liver resection that aims to achieve minimal blood loss. 30 patients underwent liver resection using RF coagulation to delineate resection margins and transect liver tissue. Results found the technique enabled practically bloodless liver resection and precise demarcation of coagulation zones, with low postoperative complication rates and blood transfusion needs for most patients.

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