Category Archives: Hepato-Biliary-Pancreatic

Incisional Hernia After Orthotopic Liver Transplantation

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Incisional hernia ‘(IH0 is a relatively common complication after liver transplant
(LT). The overall incidence of 15.1% reported within this analysis is comparable to that documented in patients undergoing “major abdominal laparotomy” where meta-analyses suggests that IH occurs at a rate approaching 13%. Within aggregate laparotomy data, procedure-specific incidences can vary considerably from the median; rates of IH after open aortic aneurysm repair, for example, exceed 30%. This highlights the importance of understanding incidence in a procedure-specific fashion. Among laparotomy patients, LT represents a unique combination of patient- and procedure-specific factors that challenge the relevance of non-transplantation data to this population; as such we have provided the first aggregate analysis of IH after LT to better understand this disease.”

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Risk of developing malignancy in congenital choledochal malformation

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“Malignancies develop in 2⋅5–26 per cent of patients with choledochal malformation. Choledochal malformations are classified according to Todani and colleagues.
Several authors consider the development of malignancy in choledochal malformations to be related to the aetiology of the different types of malformation. It could be speculated that prolonged reflux of pancreatic secretions into the biliary tract occurs in Todani types I and IV,
which frequently present with abnormal pancreaticobiliary duct junctions. Prolonged reflux might lead to malignant degeneration of the biliary epithelium. The situation is supposedly different in types II and III choledochal malformations, which might be true congenital malformations in which reflux is absent”

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SAGES guidelines for the use of intraoperative imaging of the common bile duct

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“The purpose of these guidelines is to provide evidence-based recommendations for the use of intraoperative imaging modalities during laparoscopic cholecystectomy. We assessed surgical outcomes that were deemed to be important to both surgeons and patients by a panel of surgeons. Specifically, the imaging modalities investigated were contrast
intraoperative cholangiography (IOC), fluorescence imaging (FI) with indocyanine green (ICG), and laparoscopic ultrasound (LUS). The target audience for these guidelines
includes surgeons and patients. A patient–physician perspective was taken, so cost-effectiveness, resources requirements, and availability of said resources were not evaluated. These imaging modalities were primarily assessed in the context of the American healthcare system. Therefore, these recommendations may not apply in settings where the relevant
technology is not easily accessible.”

“Laparoscopic cholecystectomy is one of the most common abdominal operations performed in the United States. Injury to the common bile duct is a rare but dreaded complication, often requiring additional surgery or endoscopic intervention. Its occurrence has been increasing since the introduction and widespread adoption of laparoscopy
(0.4–1.5% of cases) compared to open cholecystectomy. Multiple factors may contribute to the risk of common bile duct injury, including the presence of acute inflammation and anatomical variability of the CBD. Strategies such as achieving the Critical View of Safety (CVS) were developed to mitigate this risk.”

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Routine or Selective Intraoperative Cholangiography?

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“Intraoperative cholangiography (IOC) helps to clarify the biliary tree anatomy, detect common bile duct (CBD) stones, and may prevent or promptly detect BDI. However,
the use of routine (RC) or selective (SC) IOC remains controversial. Some authors have suggested that RC allows for early detection of BDI and repair in the same surgical
procedure, reducing morbidity and mortality.6–8 Also, IOC facilitates the detection and treatment of CBD stones, reducing potential complications and readmissions. In
contrast, opponents emphasize that RC often detects asymptomatic CBD stones leading to unnecessary procedures, increases operating time, costs, and exposes the surgical team and patients to radiation.”

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Operative Outcomes for Polycystic Liver Disease

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“Currently, there are no effective medical therapies proven to benefit symptomatic PCLD. Some data exist to support the use of somatostatin analogs in the treatment of hepatomegaly due to PCLD; however, the durability of their efficacy remain in question. Vasopressin receptor antagonists, ursodeoxycholic acid, and protein kinase inhibitors
have also been investigated in the management of symptomatic PCLD, but none has been shown to reduce liver volume sufficiently for symptom improvement. With the lack of medical therapies, management of advanced PCLD relies on procedural intervention. Cyst aspiration may be sufficient in patients with a single large cyst; however, with the innumerable cysts present in PCLD, aspiration is frequently ineffective.”

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Role of right hepatic lobectomy in the treatment of isolated right-sided hepatolithiasis

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“Hepatic resection has been thought to he the most effective treatment modality for selected patients who have left-sided hepatolithiasis and meet the criteria of resection.” Under the same criteria the role of right hepatic resection, especially right hepatic lobectomy, is still ambiguous for patients who have right-sided hepatolithiasis because of the higher operative risk. This report presents the results of right hepatic lobectomy in the treatment of patients with right-sided hepatolithiasis after careful selection. In particular, we focus on the
rationale and indications for this procedure,”

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Selection of pancreaticojejunostomy technique after pancreaticoduodenectomy: duct-to-mucosa anastomosis is not better than invagination anastomosis

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“Pancreaticoduodenectomy (PD) is a complex, high-risk standard surgical procedure that is indicated primarily for periampullary diseases. Central to the entire discipline of PD are postoperative mortality and morbidity. Although operative mortality in patients undergoing PD has decreased, the incidence of postoperative morbidity remains high at 40% to 50%. Postoperative pancreatic fistula (POPF) is the most common complication, with rates ranging from 5% to 30% in previous studies. Many methods have been described to decrease the risk of POPF, including the use of medications (prophylactic octreotide, sealants), prophylactic pancreatic stenting, and improvements in pancreatic reconstruction techniques. The most commonly used pancreatic reconstruction techniques are pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ).”

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