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PubMed2006

[The balloon dissector in expander treatment: A ten-year experience in plastic and reconstructive surgery].

BACKGROUND: The use of the balloon dissector ("space maker") for the implantation of soft tissue expanders is illustrated and technical aspects and advantages are compared to the conventional method. PATIENTS AND METHODS: Over a 10-year period a group of 90 patients with evaluation records (m = 34, f = 56) was analysed retrospectively. The mean age was 23 years (range: 5 to 62 years). Overall, 164 expanders were implanted and in 73 cases (44.5%) a balloon dissector was used. RESULTS: The mean intraoperative expander filling was increased up to 27% of the volume of the tissue expander after using the balloon dissector; in contrast it was 15% after conventional dissection. The mean duration of expansion was decreased by 9.8% after space maker dissection. CONCLUSION: The use of the space maker is a scar-sparing technique. Time of operation and overall duration of expansion are reduced. Patient comfort is clearly improved. The negligible costs of a space maker are compensated by the cost reduction due to shorter operating time, fewer outpatient contacts and a low complication rate. The indications for the use of balloon dissectors are the expansion of skin (scar correction after burns, trauma, tumour), breast reconstruction and augmentation, and the prefabrication and rapid intraoperative expansion of musculocutaneous flaps.

Adolescent↗

PubMed2006

Curative resection of rectal carcinoid tumors with transanal endoscopic microsurgery.

BACKGROUND: Transanal endoscopic microsurgery is a minimally invasive technique for local resection of rectal tumors. Its place needs to be defined for resection of carcinoid tumors of the rectum. MATERIALS AND METHODS: From 1998 to 2004, rectal carcinoid tumors were diagnosed in 5 patients. The diagnosis was suggested at biopsy in all patients. All tumors were resected full thickness with transanal endoscopic microsurgery. Data were obtained retrospectively from a review of hospital charts. RESULTS: At the time of operation all tumors were small without clinical or biochemical signs of metastasis. All resected tumors were highly differentiated and had free margins without invasion into the submucosa. Operative times ranged from 15 to 35 minutes. Hospital stays ranged from 2 to 4 days. No morbidity or mortality was observed. Follow-up ranged from 3 to 75 months. No recurrences were observed. CONCLUSION: Transanal endoscopic microsurgery is an excellent technique for removal of carcinoid tumors of the rectum and even the distal part of the sigmoid, if the diameter is <1 cm without invasion of the rectal wall.

Adult↗

PubMed2004

Developing a virtual reality application for training nuclear power plant operators: setting up a database containing dose rates in the refuelling plant.

Operators in Nuclear Power Plants can receive high doses during refuelling operations. A training programme for simulating refuelling operations will be useful in reducing the doses received by workers as well as minimising operation time. With this goal in mind, a virtual reality application is developed within the framework of the CIPRES project. The application requires doses, both instantaneous and accumulated, to be displayed at all times during operator training. Therefore, it is necessary to set up a database containing dose rates at every point in the refuelling plant. This database is based on radiological protection surveillance data measured in the plant during refuelling operations. Some interpolation routines have been used to estimate doses through the refuelling plant. Different assumptions have been adopted in order to perform the interpolation and obtain consistent data. In this paper, the procedures developed to set up the dose database for the virtual reality application are presented and analysed.

Computer Simulation↗

PubMed1979

Gastric partitioning for morbid obesity.

The complication rate in jejunoileal bypass for morbid obesity is unacceptably high. Gastric bypass is technically difficult. In our series, 115 patients have undergone gastric partitioning for morbid obesity. The operation consists of stapling across the stomach below the gastroesophageal junction, leaving a gastric food reservoir of 50--60 cc. A 1 cm opening is left in the central portion of the staple line, allowing slow emptying into the distal stomach. The result is a reduced eating capacity and frequency which produce loss in weight. Three-quarters of the patients are women, and the age range is 17--62 years. Preoperative weights averaged 147 kg. Mean operative time was 48 minutes, and postoperative stay was 6.2 days. All patients were extensively evaluated preoperatively with upper GI series, cholecystogram, a number of blood chemistry tests, and endocrinologic and psychiatric consultations. All patients underwent a preoperative Minnesota Multiphasic Personality Inventory test. Cholecystectomy for cholelithiasis was performed on 18% of the patients at the time of operation. Of the seven patients operated on more than one year ago, five have lost an average of 31.6% of their preoperative weight. Of the 12 operated on less than one year but more than six months ago, eight have lost an average of 21% of their initial weight. The early failure rate of 33% has been reduced to 15% at present. One death occurred from pulmonary embolus 10 days following discharge, giving a mortality rate of .08%. The complication rate is 10%, comprising two pulmonary emboli, two psychoses, one wound dehiscence, one wound hernia, and ten wound infections, six of which were minor. There have been no complications of ulcer disease, reflux esophagitis, liver disease, renal disease, or metabolic disorders. Gastric partitioning is a safe, fast effective alternative for the surgical treatment of morbid obesity.

Adolescent↗

PubMed1986

Abdominoplasty combined with gynecologic surgical procedures.

Cosmetic surgery of the abdomen is requested frequently by patients and is being performed increasingly at the time of elective gynecologic surgery. However, little information is available regarding the safety of combining these procedures. In this study intraoperative and postoperative morbidity was compared in the following groups of patients: 1) abdominoplasty plus one of five common gynecologic procedures (N = 76); 2) one of the five gynecologic procedures alone, matched for age, weight, and time of operation (N = 76); and 3) abdominoplasty alone (N = 70). Patients in group 1 experienced significantly longer operative time, longer hospital stays, and greater blood loss, which required more transfusions than group 2 or 3. These problems were accentuated in patients who weighed more than 70 kg or were older than age 35. In addition, five patients (6.6%) in group 1 had a documented pulmonary embolus within 18 days of surgery, whereas no pulmonary emboli occurred in group 2 or 3. Because of the increased morbidity, careful patient selection is necessary when abdominoplasty and gynecologic procedures are performed at the same time.

Abdomen↗

PubMed2002

The effects of different hernia repair methods on postoperative pain medication and CRP levels.

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 +/- 41.6 mg/L), Lichtenstein (138.4 +/- 72.5 mg/L), and Bassini repair (137.2 +/- 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 +/- 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 +/- 189.1 mg), Bassini (303.2 +/- 173.7 mg), and Lichtenstein (253.9 +/- 129.3) procedures compared with 196.6 +/- 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.

Adult↗

PubMed2000

Hepatectomy using an ultrasonically activated scalpel for hepatocellular carcinoma.

BACKGROUND: The first retrospective studies were performed to compare the efficacy of the ultrasonic cavitational aspirator (aspirator group) and the ultrasonically activated scalpel (scalpel group) for hepatic resection in patients with hepatocellular carcinoma. PATIENTS AND METHODS: The aspirator group consisted of 8 patients (6 with liver cirrhosis and 2 with chronic hepatitis in the nontumorous liver), and the scalpel group of 7 patients (6 with liver cirrhosis and 1 with chronic hepatitis). All patients underwent limited hepatic resection, and the intermittent Pringle maneuver was applied during hepatic transection. RESULTS: There were no significant differences in preoperative hepatic function, type of hepatectomy, tumor size and maximum cross-sectional area of the resected specimen between the 2 groups. The amount of intraoperative blood loss was significantly less in the scalpel group than in the aspirator group (684 versus 1,859 ml, p < 0.05). The operation time was significanly shorter in the scalpel group than in the aspirator group (176 versus 262 min, p < 0.05). There were no significant differences in postoperative liver function and morbidity between the 2 groups. CONCLUSIONS: The ultrasonically activated scalpel is effective in reducing blood loss and in shortening the time of operation, and can be employed during limited resection of the liver with cirrhosis or chronic hepatitis.

Aged↗

PubMed2003

Coronary artery bypass grafting for patients with poor left ventricular function.

Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction: group 1 comprised 131 patients with poor left ventricular function (ejection fraction < 40%); group 2 was 1,496 control patients. The mean number of distal anastomoses was not significantly different in the 2 groups, however, clamp time, pump time, and operative time were longer in group 1. Patient recovery was significantly slower in group 1. Morbidity (14.5% in group 1 versus 7.4% in group 2, p < 0.005) and mortality (2.3% versus 0.1%, p < 0.0001) were higher in group 1. During late follow-up, the 5-year survival rate (70.1% versus 90.5%) and 5-year event-free rate (65.6% versus 81.9%) were significantly inferior in group 1 compared to group 2. The results of bypass surgery in cases of decreased left ventricular function were poor, and such patients need to be carefully followed up.

Adolescent↗

PubMed1993

The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule.

To determine the value of routine, preoperative, fiberoptic bronchoscopy (FB) for diagnosing and treating patients (pts) with solitary pulmonary nodules (SPNs), we retrospectively reviewed the records of all pts with SPNs undergoing FB at Walter Reed Army Medical Center between January 1986 and December 1989. We defined SPNs radiographically as < or = 6 cm peripheral pulmonary lesions completely surrounded by pulmonary parenchyma. Of 191 charts reviewed, 91 (72 bronchogenic carcinomas [BC], 7 carcinoid tumors, 12 benign) constitute the study population. Fifty-four charts were eliminated because preoperative, clinical-radiologic staging revealed advanced (greater than stage I) BC or extrathoracic malignancy metastatic to the lung (44), the clinicians suspected benign disease and elected medical followup (3), the pt had medically inoperable disease (3), or the pt refused surgery (4). Forty-six charts were incomplete or unavailable. Fiberoptic bronchoscopy revealed one unsuspected vocal cord carcinoma and no occult synchronous BCs. Five pts had submucosal or endobronchial tumors and biopsy specimens showed BC in four of five tumors from which specimens were taken. Four of 66 (6 percent) cytologic evaluations of bronchial brushings or washings diagnosed BC. In pts shown at surgery to have BC, 9 of 30 transbronchial lung biopsy (TBBx) specimens showed BC. Diagnostic yield of TBBx specimens was not improved in the pts who underwent biopsies under fluoroscopic guidance. The 16 FB specimens positive for BC concurred 100 percent with the surgical specimens. The FB findings did not obviate the need for surgery nor alter the surgical stage of BC. A preoperative diagnosis of malignancy did not affect operative time or operative procedure, because many pts required frozen-section biopsy of mediastinal lymph nodes prior to lung resection. At our institution, routine, preoperative FB did not measurably benefit pts with SPNs.

Bronchoscopy↗

PubMed1999

Anterior limited thoracotomy with intrathoracic illumination for lung cancer: its advantages over anteroaxillary and posterolateral thoracotomy.

STUDY OBJECTIVE: We developed anterior limited thoracotomy (ALT) with intrathoracic illumination for curative resection of lung cancer. The present study evaluated the benefits of ALT by retrospective comparison with anteroaxillary thoracotomy (AAT) and posterolateral thoracotomy (PLT). DESIGN: Lung cancer patients, who underwent lobectomy via ALT (n = 28), AAT (n = 28), and PLT (n = 28), were matched by gender and age. Operating time, blood loss during operation, chest tube drainage volume 24 h after surgery, chest tube drainage duration, and vital capacity (VC) and chest pain from early to late postoperative period were studied for ALT, AAT, and PLT. Early postoperative chest pain was evaluated by a visual analog scale and analgesic requirements, and chronic pain was divided into five grades. RESULTS: No difference was observed in operating time among ALT, AAT, and PLT. ALT has the following advantages over PLT: (1) less blood loss during surgery (p < 0.05); (2) reduced postoperative drainage volume (p < 0.05) resulting in shorter chest tube drainage (p < 0.001); (3) diminished impairment of VC for 1 week to 6 months after surgery (p < 0.01 or p < 0.001); and (4) reduced pain from 1 day and 6 months after surgery (p < 0.001). ALT also has the advantage over AAT in reduced pain 5 days (p < 0.01) and 7 days (p < 0.05) after surgery and in decreased analgesic requirements during 14 days after surgery (p < 0.05). CONCLUSION: ALT is a sufficient and minimally invasive thoracotomy alternative to PLT or AAT for curative lung cancer resection.

Aged↗

PubMed2001

Starting a successful bariatric surgical practice in the community hospital setting.

BACKGROUND: 3% of the population is morbidly obese and experience many associated medical problems. Surgical procedures have been shown to achieve sustained weight loss not attainable by other measures, lessening the co-morbidities. However, most general surgeons have been reluctant to expand their practice to include bariatric surgery. The current study demonstrates the benefits of including bariatric surgery in a general surgeon's practice in a community hospital. METHODS: Hospital charts of patients undergoing a gastric bypass procedure between 1997 and 2000 were reviewed. Demographic data, co-morbid conditions, intra-operative times, and post-operative weight loss were recorded. Follow-up data was obtained using a mailed survey based on the BAROS survey. RESULTS: 168 patients underwent a Roux-en-Y gastric bypass procedure. Follow-up was obtained for 86 patients. Average pre-operative weight was 141 kg (BMI = 50). There was an average loss of 55% of excess weight by the second post-operative year. Operative times decreased as the number of the procedures performed by the surgeon increased. Over half of the patients surveyed reported improvements for each of the co-morbid conditions that were assessed (i.e., diabetes, back pain, etc.). Five categories of quality of life were assessed, and over 66% of patients reported improvements in all areas. In 44% of the patients, payment was obtained from private insurance and 56% from Medicare or Medicaid. There were no deaths. CONCLUSION: Adding bariatric surgery to a general surgeon's practice in the community setting can be beneficial to patients, intellectually stimulating and emotionally rewarding for the surgeon, and economically feasible for the institution.

Adult↗

PubMed1978

Intracranial saccular aneurysms--surgical results of 1,000 consecutive cases.

The results of our surgical treatment of 1,000 patients with intracranial saccular aneurysm were analyzed with special consideration for age, site of aneurysm, preoperative condition and operative timing. The results on discharge were as follows: 543 cases, excellent; 186, good; 117, fair; 93, poor; and 61, dead. About three-fourths of the cases except for 23 cases of vertebrobasilar aneurysm showed either excellent or good result. The mortality rate became worse with aging. The results fairly correlated with the preoperative grades by Hunt and Hess (1968), but the cases of Grade Ia were unexpectedly worse. The timing of operation influenced the mortality rate; especially, the cases operated within 3 to 7 days following the last subarachnoid hemorrhage bore poor results. Follow-up studies revealed that excellent and good cases increased and poor cases decreased. The mortality rate for each year decreased annually to 2% in 1975. This improvement may be attributed to the advancement in the operative management with supplementary procedures and in the treatment for cerebral angiospasms and general condition.

Adult↗

PubMed2004

Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.

OBJECT: Patients with metastatic spine tumors often have multicolumn involvement and high-grade epidural compression, requiring circumferential decompression and instrumentation. Secondary medical and oncological issues add morbidity to combined approaches. The authors present their experience in using the single-stage posterolateral transpedicular approach (PTA) to decompress the spine circumferentially and to place instrumentation. METHODS: From September 1997 to February 2004, 140 patients with spine metastases underwent the PTA. Magnetic resonance imaging revealed high-grade spinal cord compression in 120 patients (86%) and lytic vertebral body destruction in all patients. Preoperatively 84 patients (60%) received radiotherapy directed to the involved level and 42 (30%) underwent tumor embolization. Following circumferential decompression, all patients underwent anterior reconstruction with polymethylmethacrylate and Steinmann pins, and posterior segmental fixation. The median operative time was 5.1 hours, the median blood loss was 1500 ml, and the median hospital stay was 9 days. Ninety-six percent of the patients experienced postoperative pain improvement and improvement in or stabilization of neurological status. In 51 nonambulatory patients with poor Eastern Cooperative Oncology Group grades, 75% regained the ability to walk. One month postoperatively 90% of patients achieved good-to-excellent performance scores. The overall median patient survival time was 7.7 months. Patients with colon and lung carcinomas had significantly shorter survival times. Major operative complications occurred in 20 patients (14.3%). Wound complications occurred in 16 patients (11.4%), but this was not correlated with preoperative radiation treatment. CONCLUSIONS: The PTA allows circumferential epidural tumor decompression and the placement of anterior and posterior spinal column instrumention. Immediate spinal stability is achieved without the use of brace therapy. This technique achieved a high success rate for pain palliation, neurological preservation, and functional improvement, while avoiding the morbidity associated with combined approaches.

Adult↗

PubMed2001

Electrolytic removal of nitrate from crop residues.

The Controlled Ecological Life Support System (CELSS) resource recovery system, which is a waste-processing system,uses aerobic and anaerobic bioreactors to recover plants nutrients and secondary foods from the inedible biomass. Crop residues contain a significant amount of nitrate. There are actually two major problems concerning nitrate: 1) both CELSS biomass production and resource recovery consume large quantities of nitric acid, and 2) nitrate causes a variety of problems in both aerobic and anaerobic bioreactors. The nitrate anion causes several problems in the resource recovery system in such a way that removal prior to the process is highly desirable. The technique proposed to remove nitrate from potato inedible biomass leachate and to satisfy the nitric acid demand was a four-compartment electrolytic cell. In order to establish the electrolytic cell performance variables, experiments were carried out using potato crop residue aqueous leachate as the diluate solution. The variables studied were the potato biomass leachate composition and electrical properties, preparation of compartment solutions to be compatible with the electrolytic system, limiting current density, nutrients removal rates as a function of current density, fluid hydrodynamic conditions, applied voltage, and process operating time during batch recirculation operation. Results indicated that the limiting current density (maximum operating current density) was directly proportional to the solution electrical conductivity an a power function of the linear fluid velocity in the range between 0.083 and 0.403 m/s. During the electrolytic cell once-through operation, the nitrate, potassium, and other nutrient removal rates were proportional to the current density and were inversely proportional to fluid velocity. The removal of monovalent ions was found to be higher than divalent ones. Under batch recirculation operation at constant applied voltage of 4.5 and 8.5 V, it was found that the nutrient removal rates were independent of applied voltage, but were proportional to the ions concentration and operating time.

Anions↗

PubMed2002

Ministernotomy in myocardial revascularization without cardiopulmonary bypass: technical aspects and early results.

OBJECTIVE: This study attempts to evaluate the feasibility of ministernotomy in beating heart coronary surgery, with special emphasis on technical aspects. METHODS: From September 1997 to September 1999, 137 patients were scheduled for off-pump coronary surgery in our institution. In 61 cases requiring revascularization of the left anterior descending artery (LAD) and right coronary artery (RCA) systems, the approach was either a reversed "L-shaped " ministernotomy (56 patients) or a "T-shaped " ministernotomy (five patients). Mean age of the ministernotomy patients was 64 +/- 10 years, and 17 of the patients were female. The mean left ventricular ejection fraction (LVEF) was 60 +/- 11% (<35% in four patients), and 32 patients (52.5%) had one-vessel disease while 29 (47.5%) had 2-vessel or 3-vessel diseases. There were seven (11.4%) urgent procedures. For these procedures, we used devices that we designed ourselves for sternal retraction and coronary stabilization. RESULTS: Five patients (8.2%) needed conversion to another method due to hemodynamic instability or ischemia, while 56 of the patients completed the procedure. Fifty-one patients (91.1%) had a single graft on the LAD, four (7.1%) had a double graft on the LAD and the right or diagonal coronary artery, and one (1.8%) had a triple graft on the LAD and two diagonal branches. Mean coronary occlusion times and operative times were 12.1 +/- 2.7 and 152 +/- 33 minutes, respectively. Mean creatine kinase value was 29.8 +/- 24.6. One patient died of acute myocardial infarction, and one patient had temporary acute renal failure. Mean in-hospital stay was 5.2 +/- 1.9 days. Of the 18 patients (32.1%) who had postoperative angiographic control (range of 1 to 13 months), 17 showed patent anastomoses, and one required percutaneous transluminal coronary angioplasty (PTCA) of the anastomosis on the LAD. Mean follow-up time for all patients was 10.8 +/- 6.4 months. Freedom from any kind of repeat procedure was 98.2%. CONCLUSION: Ministernotomy is a safe approach for patients not requiring grafts on the circumflex system. The possibility of multiple grafting and the easy conversion to a conventional surgical method make ministernotomy a preferable approach for minimally invasive coronary surgery.

Adult↗

PubMed2002

[The medial saphenous hetero (cross leg) flap in coverage of soft tissue defects of the leg and foot].

PURPOSE OF THE STUDY: Reconstruction of large areas of soft tissue defects of the lower limb is a major challenge, particularly when the zone involves the lower part of the leg and the foot. The cross-leg flap can be a reliable alternative to free flaps, both in adults and children. We analyzed our experience in a retrospective series of 26 patients who underwent a standardize surgical procedure. MATERIAL AND METHODS: Twenty-six cross-leg flap procedures were performed between 1984 and 2000 using the same technique. Mean patient age was 32 years (range 7-67 years). All patients were trauma victims. Mean delay from trauma to flap reconstruction was 2.5 years (range 18 days-16 years). A free flap or loco-regional flap for coverage had been unsuccessful in 19 patients. The zones involved were: leg (n=7), anterior ankle area (n=3), malleolar area (n=2), dorsal aspect of the foot (n=1), heal (n=11, including 4 in an exclusively non-weight-bearing area). Mean patient follow-up was 3 years (1-10 years). The same surgical technique with external fixation was used for all patients. The flap was harvested according to a standard technique with ratios ranging from 3: 1 to 4: 1. The donor site and the flap pedicle were covered with a thin skin flap, at least during the first operative time. During the first operative time, the recipient site was resected to the exact size of the flap, the remaining coverage was achieved during the weaning process using part of the flap pedicle. Weaning was achieved after a mean 27 days (21-38 days). RESULTS: Complete flap necrosis occurred in one case and partial necrosis in six. Punctual necrosis was observed in five cases requiring revision surgery or local care. One abscess of the donor site occurred two years after flap reconstruction. Coverage was satisfactory for leg and ankle reconstructions, with no recurrent ulcerations or hyperkeratosis at last follow-up. A satisfactory esthetic aspect was achieved in all cases. For foot reconstructions, ulcerations or hyperkeratosis of the plantar skin-flap junction was observed in five cases. All of the patients were however able to wear normal shoes and felt there had been an improvement after surgery. DISCUSSION: The cross-leg flap procedure should, in our opinion, be used in three situations. i) After failure of other techniques: results are very reliable for salvage procedures; 19 of our 26 patients had had failed free or loco-regional flap procedures prior to the cross-leg flap. ii) The reconstruction is large and blood supply contraindicates a free flap procedure (only one intact vascular axis). iii) The entire heal area to be reconstructed would be insufficiently covered by a free flap. Most of the long-term problems are related to heal coverage in weight-bearing areas.

Abscess↗

PubMedDate not supplied

Postoperative management for donor safety in living related donor liver transplantation.

BACKGROUND/AIMS: Living related donor liver transplantation must hold on in absolute donor safety. Nevertheless, the risks to the donors are increased because of the use of right lobe for size mismatch. Therefore the intensive management for donor operation can hardly be overestimated. In this study, we investigated the utility of prostaglandin E1, methylprednisolone and C-tube in the postoperative management for donor operation based on our understanding of the mechanisms of liver injury after massive hepatectomy. METHODOLOGY: Outcome of the thirteen donors, whose right lobe was removed (right lobe group: 7 cases) or the left lobe only (3 cases) and left lobe plus caudate lobe (3 cases) (left lobe group: 6 cases) from 1999 March to 2000 August, for living related liver transplantation were evaluated. Indication for right lobe living related liver transplantation was basically defined as an estimated left lobe volume/recipient body weight ratio (GVBW ratio) of < 0.8% (range: 0.65-1.4, right lobe group: 1.05 +/- 0.18, left lobe group: 0.89 +/- 0.16). RESULTS: The donors recovered from the operation without the differentiation between right and left lobe group. There were no significant differences in the operative time, the operative hemorrhage, the hospital stays and the postoperative liver function in the two groups. They had no bile leakage and no serious complications. We experienced the left lobe donor who suffered from a cholangitis without any infection and he recovered by the administration of prostaglandin E1 and steroid. They improved bile secretion and bilirubinemia. Eleven recipients (84.6%) were successfully treated. The two causes of death were the sepsis (right lobe) and brain hemorrhage (left lobe). CONCLUSIONS: The current series of right lobe donation was able to show successful results as well as left lobe donation by the postoperative management with steroid, prostaglandin E1 and C-tube drainage based on our understanding of liver injury after massive hepatectomy in the adult-to-adult living donor liver transplantation.

Adult↗

PubMedDate not supplied

Postoperative evaluation of C-tube drainage after hepatectomy.

BACKGROUND/AIMS: In spite of recent advances in liver surgery, biliary complications remain a common cause of major morbidity after hepatectomy. METHODOLOGY: We studied the postoperative evaluation of 28 hepatectomied patients with transcystic duct tube (C-tube) drainage (C-group), compared with 38 hepatectomied patients without C-tubes (NC-group), in terms of preoperative clinical profiles of patients, intraoperative findings and procedures, postoperative management and bile leakage, daily output of bile, liver function and postoperative infections. RESULTS: There were no significant differences in the preoperative clinical profiles of patients and postoperative management between the two groups. In intraoperative findings and procedures, the tumor size, weight of the resected liver, operation time and operative blood loss were higher in the C-group than those in the NC-group. Therefore, the operative procedure was more serious in the C-group than that in the NC-group. However, bile leakage was observed in only one of 28 patients (3.6%) in the C-group and 10 of 38 patients (26.3%) in the NC-group, that is, bile leakage occurred less frequently in the C-group than in the NC-group. The daily output of bile in the C-group was thought to be enough to decompress the biliary tree. In liver function, aspartate aminotransferase and alanine aminotransferase had lower levels in the C-group than those in the NC-group with bile leakage. White blood cell count, C-reactive protein and body temperature were closer to the normal range in the C-group than those in the NC-group with bile leakage. CONCLUSIONS: C-tube drainage after hepatectomy is thought to be useful for decreasing postoperative complications, especially bile leakage.

Aged↗