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Biomedical subjects

Carlos Chan

Publications and source records attributed to Carlos Chan.

26 records · Page 2Linked to original sources
PubMedDate not supplied

Complete resection of choledochal cyst with Roux-en-Y derivation vs. cyst-enterostomy as standard treatment of cystic disease of the biliary tract in the adult patient.

BACKGROUND/AIMS: Cystic disease of the biliary tract (CDBT) is characterized by varying degrees of dilatation of the biliary system with high morbidity and mortality in which the surgical management is the corner stone of treatment. The cyst-enterostomies (CE) temporarily solve the obstruction to the biliary flow but have a high long-term morbidity. Complete resection of affected bile ducts with Roux-en-Y derivation (CRR-en-Y) is a good procedure with low mortality and complications. The purpose of the study was to analyze the outcome of CRR-en-Y versus CE in the treatment of CDBS in adult patients from 1970 to 2002. METHODOLOGY: Patients who underwent surgical treatment were divided for their analysis into two groups: Group I: CRR-en-Y and Group II: CE. Following features were compared: demography, clinical picture, postoperative morbimortality, outcome and survival. RESULTS: Thirty-four adult patients were analyzed. There were 82% (28) females and 18% (6) males. The age average was 33.58 years (13-84). Seventy percent (30) were "choledochal cyst". Eighty percent (27) were surgically handled: 52% (14) with CRR-en-Y (Group I) versus 58% (13) with CE (Group II). Both groups were comparable. Without operative mortality and low postoperative morbidity in both, CE had more long-term complications: In this group 70% (9) were readmitted: and 7 underwent reoperation. Mean follow-up was 35 months (6-132) versus 152 months (12-408) respectively. CONCLUSIONS: CRR-en-Y is the standard treatment of CDBS in the adult patient.

Adolescent↗
PubMedDate not supplied

Prognostic implications of preserved bile duct confluence after iatrogenic injury.

BACKGROUND/AIMS: Biliary reconstruction is performed according to the level of the injury. A comparative study between patients in whom the biliary junction was preserved and another group where the biliary junction was not preserved was done. METHODOLOGY: A retrospective review of the biliary reconstructions performed at our institution after iatrogenic lesions between 1990-2002 was done. Postoperative outcome, functional status of the anastomosis, recurrent cholangitis, need for radiological instrumentation and/or reoperation were analyzed. RESULTS: We reviewed 204 cases, 130 cases had a preserved biliary junction while in 74 the injury included the junction. All patients were treated with a Roux-en-Y hepatojejunostomy. In the first group, 4% required reoperation, 4% underwent radiological percutaneous instrumentation, 8% had anastomotic dysfunction and 4% cholangitis. In the second group, 24% needed reoperation and 80% radiological instrumentation. Anastomotic dysfunction was observed in 64% and cholangitis in 55%. It is important to note that 52 of the 74 cases in the second group had a history of more than two reconstruction attempts. CONCLUSIONS: When the biliary junction is preserved after a iatrogenic injury we found a significantly better outcome. The results of biliary reconstruction in this type of patient are better long-term compared to those where the junction was not preserved, evidenced by a lower reoperation and radiological instrumentation rate.

Adolescent↗
PubMedDate not supplied

[Cystic disease of the biliary tract. Three decades of institutional experence].

INTRODUCTION: Cystic disease of biliary tract (CDBT) characterizes by the presence of sacular expansions of the biliary tree. It is an uncommon disease associated with high morbidity and malignant transformation. More than 60% of patients are women and can be diagnosed in the adult life. OBJECTIVE: To evaluate the results obtained during last three decades in the management of CDBT in the adult patient. PATIENTS AND METHODS: All the patients with CDBT treated from 1970 to 2002 were included. Demographic data, clinical picture, boarding diagnosis, classification, treatment, evolution and survival were analyzed. RESULTS: 34 patients. Twenty eight (82%) women and 6 (18%) men with a mean age of 33 years (range 13-84). The most frequent symptoms were abdominal pain, nausea-vomit and jaundice. Cholangiography was made in all cases. All the types described by Todani were documented. Twenty-seven patients (80%) were surgically treated. The mean follow-up was 84 months (range 1-408 months). Fifteen patients (44.1%) were readmitted and 9 (26.4%) had a reoperation. Three (9%) died with malignant transformation. The global survival was 91.1% to 12 months. CONCLUSIONS: In the adult patient, diagnosis of CDBT requires a high level of suspicion and its confirmation depends on the image studies. The CDBT diagnosis considers an indication of surgical treatment. Complete resection of the biliary tract with Roux en-Y hepato-jejunal anastomosis have less rate of mechanical complications, hospitalary readmissions and surgical reintervention.

Adolescent↗
PubMedDate not supplied

Low serum albumin is not a contraindication for early iatrogenic bile duct injury repair.

UNLABELLED: Most iatrogenic bile duct injuries are recognized in the early postoperative period (first 48 hours). These patients usually have additional complications such as a suboptimal hydroelectrolitic status, subhepatic collections, external biliary fistula and malnutrition. In these circumstances, besides the elevation of bilirubin and transaminases associated with the injury, hypoalbuminemia is frequently encountered. The timing for repair is decided according to the condition of each patient. We report the impact of preoperative abnormal low serum albumin levels on the results of biliary tract reconstruction after a iatrogenic biliary lesion. METHOD: Patients who underwent biliary reconstruction in our center from 1998 to 2002 were analyzed. Only patients with complex injuries (Strasberg E, Bismuth III-IV, Stewart-Way III) were included. Major postoperative complications were recorded and correlated with preoperative liver function tests. RESULTS: Seventy seven patients were analyzed. In 41 cases, the injury was a consequence of a laparoscopic operation. All patients were treated by a Roux-en-Y hepatojejunostomy. No operative mortality was recorded. The most frequent postoperative complications were postoperative biliary fistula (8/77-9%, p < 0.017) and subhepatic collections (9/77-9%, p < 0.39). All fistulae closed spontaneously and the subhepatic collections were drained. Overall, complications were more common in the group with hypoalbuminemia (p < 0.002). CONCLUSION: Early repair is indicated if there is no systemic contraindication (sepsis, multiple organic failure, electrolytic imbalance). Abnormalities in the liver function tests, particularly a low serum albumin, should not delay the operation. Although significantly more postoperative complications are observed in an early repair, long-term results are comparable to those of an elective repair.

Adolescent↗
PubMedDate not supplied

[Surgical techniques in liver transplantation].

Liver transplantation (LT) is probably the biggest surgical aggression that a patient can endure. It was considered only as a last option in the era of experimental LT, yet it evolved into the definitive treatment for some types of acute and chronic end stage liver disease. In terms of technique LT is the most complex of all types of transplantations. The surgical procedure in itself is well established and has changed little through time. Liver transplantation owes its improvement to better and more systematic anesthetic procedures and to perioperative care more than being due to improvement of the surgical technique. The first surgical procedure was described by Thomas Starzl in 1969. His initial work has been strengthened with the development of venous bypass, the refinement in vascular and biliary reconstruction technique and the development of the split liver. Up to date technical aspects of orthotopic liver transplantation are described in the present article.

Anastomosis, Surgical↗
PubMedDate not supplied

Bile duct injuries related to misplacement of "T tubes".

INTRODUCTION: T tubes can be placed in the bile ducts either open or laparoscopically for several reasons such as: extraction of stones, biliary reconstruction after liver transplant and in end-to-end anastomosis in iatrogenic injuries. Inadequate placement of the T tube, long term stay and technical difficulties that can affect the outcome, can lead to an injury that usually requires a biliodigestive reconstruction. METHODS: In a 15-year period (1990-2005) a total of 343 patients have been referred to our university hospital for biliary reconstruction. Files of those patients in which the injury was due to misplacement of a T tube or associated with a long-term stay were reviewed. We evaluated the type of injury, technique used for the reconstruction, longterm staying of the T tubes (1-6 months), hospital in stay, long term outcomes as well as associated comorbidities. RESULTS: In 42 cases a biliary injury related to a T tube was identified (13%). All the injuries were classified as Strasberg E, with demonstration of a fistula (internal or external); 18 to the duodenum, 5 to the jejunum-ileum and 3 to the colon. A hepatojejunostomy was done to all patients; the duodenum and small gut fistulas were closed and in the 3 cases with colonic injury a right hemicolectomy was performed. The postoperative evolution was adequate without major complications but with a longer hospital stay. In 39 of the 42 patients (92%), good postoperative results were obtained. Only one case required a new surgery (22 months after the first one), due to recidivant cholangitis. CONCLUSION: Inadequate placement of the T tubes and long-term stay can produce complex biliary injuries with associated comorbidities such as fistulas to the adjacent viscera. Placement of T tubes need a careful surgical technique and their indication must be carefully assessed.

Adult↗
PubMedDate not supplied

[Pancreatoduodenectomy: results in a large volume center].

OBJECTIVE: Analyze the experience with pancreaticoduodenectomy (PD) at the INCMNSZ. BACKGROUND DATA: PD has become a popular procedure in hospitals throughout the USA and Europe in the last 25 years, where mortality is < 5% y morbidity remains around 40%. Nonetheless there are very few reports on PD in Latin America. METHODS: The data of all PD's performed at the INCMNSZ between 1999 and 2005 was gathered prospectively and analyzed retrospectively. RESULTS: 133 PDs where performed; 47.5% where men and 52.5% where women. Median of age was 57.7 years. 81.5% underwent classical resection and 18.5% a pylorus preserving procedure. Intraoperative variables include: blood loss: 940 mL. (1,000). transfusion requirements: 1.9 U, median operative time: 5:49 (+/- 1:02) and median hospital stay: 14 days. Most frequent diagnosis include ampulary adenocarcinoma and pancreatic cancer Mortality in the entire series was 9.2%, decreased to 2.7% in the 2002-2005 period and from April 2003 has remained in 0. A total of 14 portal-superior mesenteric vein resections where performed. CONCLUSIONS: To our knowledge this is the largest series of PD in Latin America. Popularity and indications for PD are expanding. Mortality is acceptable and morbidity remains high despite much effort. This procedure is performed with a satisfactory outcome in high volume centers. Involvement of the portal-superior mesenteric vein is not a contraindication of PD.

Adenocarcinoma↗