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Salleh Ibrahim

Publications and source records attributed to Salleh Ibrahim.

9 recordsLinked to original sources
PubMed2007

Liver resection for benign liver tumors: indications and outcome.

BACKGROUND: The indications for intervention in cases of benign liver tumors include symptoms, suspicion of malignancy, or risk of malignant change. METHODS: Eighty-four liver resections for benign tumors were performed in our hospital from June 1996 to December 2004. The patient records were reviewed retrospectively. RESULTS: The study group (41 females, 43 males; average age, 41.4 +/- 10.5 y) included 46 cavernous hemangiomas, 27 focal nodular hyperplasias, 5 hepatic adenomas, and 6 liver cysts. The indications for resection were inability to rule out malignancy (50 [59.5%]), symptoms (33 [39.3%]), and others (1 [1.2%]). Postoperatively, 28 of the 33 patients had resolution of symptoms. Twenty-nine patients (34.5%) had chronic hepatitis B infection. CONCLUSIONS: Liver resection for benign liver tumor is safe, but indications for intervention must be evaluated carefully. The presence of chronic parenchymal liver disease does not increase morbidity in these patients.

Adenoma↗
PubMed2006

Small remnant liver volume after right lobe living donor hepatectomy.

BACKGROUND: Right lobe living donor liver transplantation has become a viable option for adult patients with end-stage liver disease, however, the safety of the donor is of paramount importance. One of the key factors in donor safety is ensuring adequate donor remnant liver volume. METHODS: We retrospectively examined donors who had less than 30% remnant liver volume after right graft procurement. Eighty-six right lobe living donor transplants were carried out in Chang Gung Memorial Hospital, Kaohsiung Medical Center, from January 1999 to December 2004. RESULTS: Eight donors had less than 30% remnant liver volume (Group 1) after graft procurement and 78 donors had remnant liver volume greater than 30% (Group 2). There were no differences in donor characteristics, types of graft, operative parameters, and post-operative liver and renal function as well as liver volume at 6 months post-donation between the 2 groups. The graft weight obtained in Group 1 donors was significantly greater compared with that from Group 2 (P<.005). The overall donor complication rate was 6.98%, and all the complications occurred among group 2 donors. CONCLUSIONS: The judicious use of donors with less than 30% remnant liver volume is safe as a last resort.

Adult↗
PubMed2006

Donor graft outflow venoplasty in living donor liver transplantation.

Hepatic venous outflow reconstruction is a key to successful living donor liver transplantation (LDLT) because its obstruction leads to graft dysfunction and eventual loss. Inclusion or reconstruction of most draining veins is ideal to ensure graft venous drainage and avoids acute congestion in the donor graft. We developed donor graft hepatic venoplasty techniques for multiple hepatic veins that can be used in either right- or left-lobe liver transplantation. In left-lobe grafts, venoplasty consisting of the left hepatic vein and adjacent veins such as the left superior vein, middle hepatic vein, or segment 3 vein is performed to create a single, wide orifice without compromising outflow for anastomosis with the recipient's vena cava. In right lobe graft where a right hepatic vein (RHV) is adjacent with a significantly-sized segment 8 vein, accessory RHV, and/or inferior RHV, venoplasty of the RHV with the accessory RHV, inferior RHV, and/or segment 8 vein is performed to create a single orifice for single outflow reconstruction with the recipient's RHV or vena cava. Of 35 venoplasties, 2 developed hepatic venous stenoses which were promptly managed with percutaneous interventional radiologic procedures. No graft was lost due to hepatic venous stenosis. In conclusion, these techniques avoid interposition grafts, are easily performed at the back table, simplify graft-to-recipient cava anastomosis, and avoid venous outflow narrowing.

Anastomosis, Surgical↗
PubMed2006

Intraoperative blood loss is a risk factor for complications in donors after living donor hepatectomy.

Complications in a donor are a distressing but inevitable occurrence, since graft procurement is a major undertaking. Although the technique for procurement has some similarities to hepatic resection, a donor is very unlike a patient with malignancy. The risk factors identified in these patients cannot be extrapolated to donors. Donor hepatectomy carried out from June 1995 to March 2005 in Chang Gung Memorial Hospital, Kaohsiung Medical Center was reviewed with the aim of identifying risk factors for complications. There were 204 living donor liver transplants, with 205 donor hepatectomies, as 1 living donor liver transplantation was a dual graft. Ten donors (4.88%) suffered complications. There was no difference in terms of age, gender, body weight, operation, and parenchymal time between those who had complications and those who did not. There was also no difference in liver function tests between the 2 groups of donors, but the total bilirubin was significantly higher in donors with complications. The graft weight and remnant liver volume were also similar. The proportion of donors with fatty liver was the same between the 2 groups. The mean blood loss in donors with complications was 170 +/- 79 mL, and that for donors without complications was 95 +/- 77 mL. There was a statistically significant greater blood loss in donors with complications (P < 0.05). The number of segments removed in donors with complications was also higher compared to donors without complications (P < 0.03). Using multivariate analysis, intraoperative blood loss and the number of segments removed were found to be independent risk factors for donor complications. Intraoperative blood loss during graft procurement must be kept low to minimize complications in donors.

Adult↗
PubMed2006

Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is the gold standard treatment for most gallbladder diseases. Conversion to open cholecystectomy is necessary in some patients for any of a number of factors. Identifying these factors will help the patient, the surgeon, and the hospital. METHODS: One thousand laparoscopic cholecystectomies were performed from May 1998 to May 2004 in Changi General Hospital, Singapore; 103 patients (10.3%) required conversion to open cholecystectomy. All data were kept prospectively and analyzed retrospectively. RESULTS: The patients who had conversion were mostly men (P < 0.0001), were heavier (P < 0.05), had acute cholecystitis (P < 0.0001), and had a history of upper abdominal surgery (P < 0.001). There were no differences in terms of race (P = 0.315) and presence of diabetes mellitus (P = 0.126). Diabetic patients who had conversion had a significantly higher glycosylated hemoglobin (Hba1c) (8.9% +/- 0.6%; P < 0.038). Patients who had conversion had a higher total white count (P < 0.05), but liver function tests were similar between the two groups. There was a higher conversion rate among the junior surgeons than the more experience surgeons (P < 0.032). CONCLUSIONS: The significant risk factors for conversion were male gender, advanced age (> 60 years), higher body weight > 65 kg, acute cholecystitis, previous upper abdominal surgery, junior surgeons, and diabetes associated with Hba1c > 6. Chronic liver disease was not found to be a risk factor (P = 0.345), and performing laparoscopic cholecystectomy in cirrhotic patients is safe. Identifying risk factors will help the surgeon to plan and counsel the patient and introduce new policies to the unit. Some of the risk factors are similar to those reported from international centers, but others may be unique to our department.

Adult↗
PubMed2005

Liver regeneration and splenic enlargement in donors after living-donor liver transplantation.

Liver regeneration after donor hepactectomy offers a unique insight into the process of liver regeneration in normal livers. As the liver restores itself, concurrent splenic enlargement occurs. There are many theories about why this phenomenon takes place: some investigators have proposed a relative portal hypertension that leads to splenic congestion or, perhaps, the presence of a common growth factor that induces both the liver and spleen to enlarge. Between the months of June 2001 and May 2004, 112 live donor liver transplants (LDLTs) were performed in Chang Gung Memorial Hospital, Kaohsiung, Taiwan. The total number of donor hepatectomies performed during this period was 113, however, because one of the cases required dual donors. Of our 113 donors, we eventually analyzed the data of 109; 4 patients were lost to follow-up 6 months later and were excluded from our study. The average age of our donor population was 32.32 +/- 8.48 years. The mean liver volume at donation was noted to be 1207.72 +/- 219.95 cm3, and 6 months later, it was 1027.18 +/- 202.41 cm3. Expressed as a percentage of the original volume, the mean liver volume 6 months after hepatectomy was 90.70% +/- 12.47% in this series. For right graft donors, mean liver volume after 6 months was 89.68% +/- 12.37% of the original liver volume, whereas that for left graft donors was 91.99% +/- 12.6%. Only 26 of the 109 (23.85%) donors were able to achieve full regeneration 6 months post-donation. Notably, liver function profiles of all donors were normal when measured 6 months after operation. The average splenic volume at donation as measured by computed tomography (CT) volumetry was 159 +/- 58 cm3, and the splenic volume 6 months post-donation was 213 +/- 85 cm3. There was a mean increment in splenic volume of 35% +/- 28% 6 months after donation. The blood profiles of the donors were monitored; particular attention was given to platelet levels and liver function tests, and these were found to be within normal limits 6 months after operation. Of note, splenic enlargement was significantly greater among right-sided donors than their left-sided counterparts. Greater splenic enlargement was also observed in those donors who achieved full liver regeneration at their evaluation 6 months postoperatively than in those who did not. Although original liver volume was not re-established in most patients 6 months after liver donation, there seemed to have been no untoward effects to the donor. The factors that affect liver regeneration are complex and myriad. Although there is splenic enlargement at 6 months post-donation in donors of LDLT, there are no untoward effects of this enlargement.

Adult↗
PubMed2005

Hartmann procedure: is it still relevant today?

BACKGROUND: With more and more centres worldwide resorting to primary anastomosis for most left sided colonic pathology, the place for a Hartmann procedure seems to be relegated to surgical history books. However, in our centre it is still being performed on a regular basis. As such, we decided to retrospectively look at our results for the procedure. METHODS: All hospital records of patients undergoing the Hartmann procedure between January 1998 and December 2001 were retrospectively analysed looking at demographics, comorbidities and indications of the procedure. RESULTS: There were 52 men and 33 women with a median age of 69 years (range 31-96 years). Sixty-six per cent of the patients had medical comorbidities at the time of the operation. The indications for performing the procedure were: 45 patients for cancer (31 patients for obstruction, 11 patients for perforation, two patients for fistulation to other organs and one for uncontrollable bleeding). 19 patients had the procedure for complicated diverticulitis while four patients had anastomotic leaks, which required conversion to the procedure. Other indications include trauma (four patients), ischemic bowel (six patients) and iatrogenic (one patient). Our median operating time was 160 min (range 50-415 min). Our reversal rate was 32%. Our mortality rate for the first stage was 16% and our morbidity, 51%. The morbidity for the reversal was 29%, with no mortalities. CONCLUSION: Though the idea of primary anastomosis with on table lavage for left sided anastomosis seems attractive, we think the Hartmann procedure is still useful for selected patients.

Adult↗
PubMedDate not supplied

Improving hepatic and portal venous flows using tissue expander and Foley catheter in liver transplantation.

BACKGROUND AND OBJECTIVE: Vascular reconstruction is important in liver transplantation because its obstruction causes graft failure and eventual loss. Vascular outflow obstruction may be due to graft malposition. We describe our experience with liver allograft repositioning using tissue expander and Foley catheter to improve hepatic and portal venous outflows. PATIENTS AND METHODS: A total of seven patients who received liver transplantation at our institution developed hepatic and/or portal venous obstruction during final graft positioning detected by Doppler ultrasonography (hepatic vein flow <10 cm/s; portal vein flow <12 cm/s). Chart and operative records of these patients were reviewed. Technique of operation, donor-recipient characteristics, use of tissue expander or Foley catheter to improve venous outflow, complications, and outcome were analyzed. RESULTS: Hepatic and/or portal venous obstruction were detected after portal reperfusion. We used commercially available tissue expander used in plastic surgery and Foley catheter to reposition the graft. Tissue expanders were used in three recipients (age: 27-46 yr). Foley catheters were used in four recipients (age: 7 months-53 yr). One recipient used both tissue expander and Foley catheter. Expanders were filled with 300-770 mL saline and placed into the right subphrenic space. Foley catheters were filled with 15-75 mL saline. Significant improvements in hepatic and/or portal venous outflow were detected by Doppler ultrasonography post-graft repositioning. Aspiration of expander and Foley catheter contents was started from 6th to 27th postoperative day under sonographic guidance. All expanders and catheters were removed by the 19th-56th postoperative day (mean: 38 d). Complications included chylous ascites (1/7), bile leak (1/7), tube drain infection (2/7), septicemia (2/7). All complications were successfully managed by non-operative interventions. There was no outflow obstruction detected by ultrasonography before and after removal of expanders and catheters. One- and two-year graft and patient survivals were both 100%. CONCLUSION: The use of tissue expanders and Foley catheters to improve hepatic and portal venous outflow in malposed liver allografts is a simple and safe method after liver transplantation.

Adolescent↗