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ABSTRACT: Few studies compare the direct impact of pancreatoduodenectomy (PD) on the patient's quality of life (QOL). The effect of PD in QOL, comparing the preoperative vs. postoperative status, was analyzed.
A prospective single-center study was performed. PD patients in a 2-year period were included. A general QOL instrument was applied preoperative, 1, 3, 6, and 12 months after surgery and compared with national norms.
Thirty-seven patients were recruited. Twenty of 37 were female. Ampullary carcinoma 14/37, ductal adenocarcinoma in 9/37, and other malignant neoplasms 14/37 were diagnosed. Mortality was absent; 48.6% had complications, 13.5 % required reoperation. Three (median) and 4 (mode) questionnaires were answered per individual. 85 % answered the last questionnaire. 4/37 had cancer related death before a year. Median follow-up was 29 (3-72) months. QOL diminished a month after surgery, physical function (67 vs 40, p<0.0001) and emotional role (37 vs 17, p<0.032) did so significantly. Three months after surgery QOL improved yet not significantly. Six and 12 months postoperatively, physical role (9 vs 49, p=0.001), physical pain (51 vs 71, p=0.01), social function (52 vs 63, p=0.014), vitality (54 vs 64, p=0.018), and emotional role (41 vs 69, p=0.006) improved significantly.
PD has a favorable impact in quality of life as demonstrated by the improvement of most parameters assessed in the postoperative period.
Journal of Gastrointestinal Surgery 05/2012; 16(7):1341-6. · 2.83 Impact Factor
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ABSTRACT: Biliary complications after orthotopic liver transplantation (OLT) are multifactorial in origin. In most series, the frequency of such complications ranges from 5-20%. Most can be treated by endoscopy and/or interventional radiology. For cases in which this option is not successful, surgical approach is indicated. We report the results of reoperation using an intrahepatic bilioenteric anastomosis.
The medical charts of patients with biliary complications after OLT during a 10-year period (1997-2007), who failed to respond to nonsurgical treatment and were surgically treated, were reviewed. Roux-en-Y hepatojejunostomy was performed. Segments IV and V were partially removed after cutting the hilar plate, thus obtaining healthy ducts without ischemic or inflammatory reaction and allowing a wide hepatojejunostomy.
Five cases (8.4%) with biliary complications after duct-to-duct anastomosis not amenable to further endoscopic management or interventional radiology were identified. Hepaticojejunostomy was achieved in all cases (wide, tension-free, nonischemic, fine hydrolyzable sutures), and segments IV and V were partially removed. No cholangitis, jaundice, and liver function test abnormalities were present in the postoperative. Mean follow-up was 24 months. Only one patient died of causes not related to bile duct reconstruction during follow-up.
Intrahepatic hepatojejunostomy with partial resection of segments IV and V offers an excellent therapeutic alternative for biliary complications that require a surgical approach after OLT.
World Journal of Surgery 02/2009; 33(3):534-8. · 2.36 Impact Factor
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ABSTRACT: Bile duct injuries related to laparoscopic and/or open cholecystectomy are a frequent finding and require surgical treatment. Complete obstruction is due to either intentionally or unintentionally placed ligatures or clips. The intentional application is usually performed to "facilitate identification of the duct by bile duct dilation." Considering that we are a national referral center for such injuries, we decided to analyze our cases of voluntary and involuntary duct ligation after iatrogenic bile duct injury.
We reviewed the files of patients with voluntary or involuntary bile duct ligation. Results of preoperative evaluation of the ducts, operative treatment, and postoperative results were analyzed.
A total of 413 patients were included. Forty-five patients presented with complete obstruction. In 15 cases, the ligature was intentional, and in 30 cases, occlusion was involuntary. Bile duct dilation (>10 mm) was demonstrated in one case of voluntary (6%) and three cases of involuntary ligations (10%). The remaining cases in both groups had no duct dilation and developed necrosis at the blinded duct and leakage proximal to the ligature, with different degrees of bilioperitoneum and/or biloma. In all cases, a Roux-en-Y hepatojejunostomy was performed.
Bile duct ligature produces dilation in a very small number of patients (less than 10%) and usually produces necrosis of the blinded stump with subsequent bile leakage. Placement of a subhepatic drain and transference of the patient to a qualified center for reconstruction is the best approach if the primary surgeon is not able to do the repair.
Journal of Gastrointestinal Surgery 06/2008; 12(6):1029-32. · 2.83 Impact Factor
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ABSTRACT: To analyze data in a single institution series of pancreaticoduodenectomies (PD) performed in a 7-year period after the transition to a high-volume center for pancreatic surgery.
PD has developed dramatically in the last century. Mortality is minimal yet complications are still frequent (around 40%). There are very few reports of PD in Latin America.
Data on all PDs performed by a single surgeon from March 2000 to July 2006 in our institution were collected prospectively.
During the study's time frame 122 PDs were performed; 84% were classical resections. Mean age was 57.9 years. Of the patients, 51% were female. Intraoperative mean values included blood loss 881 ml, operative time 5 h and 35 min, and vein resection in 14 cases. Both ampullary and pancreatic cancer accounted for 34% of cases (42 patients each), 5.7% were distal bile duct and 4% duodenal carcinomas. Benign pathology included chronic pancreatitis, neuroendocrine tumors, cystic lesions, and other miscellaneous tumors. Overall operative mortality was 6.5% in the 7-year period, 2.2% in the later 5 years. There was a total of 75 consecutive PDs without mortality. Of the patients, 41.8% had one or more complications. Mean survival for pancreatic cancer was 22.6 months and ampullary adenocarcinoma was 31.4 months.
To our knowledge, this is the largest single surgeon series of PD performed in Latin America. It emphasizes the importance of experience and expertise at high-volume centers in developing countries.
Journal of Gastrointestinal Surgery 04/2008; 12(3):527-33. · 2.83 Impact Factor
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ABSTRACT: The frequency of bile duct injuries associated to cholecystectomy remains constant (0.3-0.6%). A multidisciplinary approach (endoscopical, radiological, and surgical) is necessary to optimize the outcome of the patient. Surgery is indicated when complete section of the duct is identified (Strasberg's E injuries) requiring a bilioenteric anastomosis as treatment. Nowadays, the most frequent technique used for reconstruction is a Roux-en-Y hepatojejunostomy. Long-term results of reconstruction are related to several technical and anatomic factors, but an ischemic duct (with subsequent scarring) plays a mayor role. In this paper, we report the results of biliary reconstructions comparing the extrahepatic-probably ischemic -- to intrahepatic -- non ischemic -- repairs.
We reviewed the files of patients referred to our hospital (third-level teaching hospital) for bile duct repair after iatrogenic injury from 1990 to July 2006. Injury classification, time lapse since injury, surgical repair technique, and long-term follow-up were noted. In all cases, a Roux-en-Y hepatojejunostomy was done. Partial resection of segment IV was performed in 136 patients to obtain noninflamed, nonscarred, nonischemic biliary ducts with the purpose of reaching the confluence and achieving a high-quality bilioenteric anastomosis. An anastomosis at the level of the confluence was attempted in 293 patients (in 198 the confluence was preserved and in 95 it was lost). In the remaining 80 patients, a low bilioenteric anastomosis was done at the level of the common hepatic duct. We compared intrahepatic (198) and extrahepatic (80) repairs.
A total of 405 cases (88 males, 317 females) were identified, with a mean age of 42 years (range 17-75). All of the injuries were classified as Strasberg E1, E2, E3, E5 (less frequent); those with E4 classification (separated ducts) were excluded. In all cases, the confluence was preserved (N = 293). Thirty-two cases were repaired minutes to hours after the injury occurred. The remaining 373 patients arrived weeks after the injury. In 198 cases, an intrahepatic repair was done, including the 136 in which resection of segments IV and V was part of the surgery. In the remaining 80 cases (operated between 1990 and 1997), an extrahepatic repair was done at the level of the common hepatic duct where the surgeon found a healthy duct. Twelve (15%) of the 80 cases with extrahepatic anastomosis required a new intervention (surgical or radiological), compared to only 8 of the 198 (3%) that had an intrahepatic anastomosis (P = 0.00062). Good results were obtained in 85% and 97% of the cases with extrahepatic anastomosis and intrahepatic anastomosis, respectively. Both groups had a reintervention rate of 7% (20/278).
An intrahepatic anastomosis requires finding nonscarred, nonischemic ducts, thus allowing a safe and high-quality anastomosis with significantly better results when compared to the low-level anastomosis group.
Journal of Gastrointestinal Surgery 03/2008; 12(2):364-8. · 2.83 Impact Factor
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Revista de gastroenterologia de Mexico 09/2006; 71 Suppl 1:42-6.
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ABSTRACT: Roux-en-Y hepatojejunostomy is the procedure of choice for biliary reconstruction after complex iatrogenic injury that is usually associated with vascular injuries and concomitant ischemia of the ducts. To avoid the ischemic component, our group routinely performs a high repair to assure an anastomosis in noninflamed, nonscarred, and nonischemic ducts. If the duct bifurcation is preserved, the Hepp-Couinaud approach for reconstruction is an excellent choice. Partial liver resection of segments IV and V allows adequate exposure of the bile duct at its bifurcation with an anterior approach of the ducts (therefore not jeopardizing the circulation), allowing a high quality anastomosis. Long-term results of bile duct reconstruction using this approach are described. Two hundred eighty-five bile duct reconstructions were done between 1989 and 2004 in a tertiary care university hospital. The first partial-segment IV resection was done in 1994; 94 cases have been reconstructed since then using this approach. All of them had a complex injury (Strasberg E1-E5), and although in many cases the bifurcation was preserved (E1-E3), a high bilioenteric anastomosis was done to facilitate the reconstruction. In 70 cases, the bifurcation was identified, and in the 24 in which the confluence was not preserved, the right and left ducts were found except in one case. In three patients, the right duct was found unsuitable for anastomosis, and a liver resection was done. In the remaining 21, an anastomosis was done using a stent (transhepatic, transanastomotic) through the right duct. According to Lillemoe's criteria, 86 cases had good results (91%). In four of the eight remaining patients, there was the need to operate again due to the presence of an obstruction and/or cholangitis. In the rest, radiological instrumentation was done. Four of these cases have developed secondary biliary cirrhosis, two of which have died while waiting for a liver transplant, four and six years after reconstruction. Partial segments IV and V resection allows adequate exposure of the confluence and the isolated left or right hepatic ducts. Anterior exposure of the ducts allows an anastomosis in well-preserved, nonischemic, nonscarred, or noninflamed ducts. Parenchyma removal also allows the free placement of the jejunal limb, without external compression and tension, obtaining a high quality anastomosis with excellent long-term results.
Journal of Gastrointestinal Surgery 02/2006; 10(1):77-82. · 2.83 Impact Factor
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ABSTRACT: Standard pancreatic resections, either proximal or distal ones, result in a considerable loss of pancreatic parenchyma and may cause impairment of the exocrine and endocrine functions. Central pancreatectomy has been indicated for small benign lesions located in the neck or body of the pancreas. It has the potential advantage of lowering the risk of functional impairment of the pancreatic parenchyma, biliary tract, upper gastrointestinal tract, and spleen. We present three cases of patients with benign, isolated pancreatic tumors who underwent a successful central pancreatectomy. From this small series, we believe that central pancreatectomy is an excellent therapeutic option for benign, localized pancreatic tumors.
The American surgeon 05/2004; 70(4):304-6. · 1.28 Impact Factor
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ABSTRACT: INTRODUCCIÓN: Los tumores de vías biliares son tumoresraros que tienen una incidencia de 1 en 100, 000 habitantes.En un paciente con este tipo de tumor la cirugía puede sercurativa en etapas tempranas, con una supervivencia a 5años de 20%, los pacientes con enfermedad avanzada tienenuna supervivencia de 6 a 7 meses y en ellos están indicadoslos procedimientos paliativos.OBJETIVO: Mostrar la experiencia en un período de 14 añosen pacientes con tumores de vías biliares y que recibieronalgún tratamiento quirúrgico con intento curativo o paliativo.METODOLOGÍA: Se trata de un estudio metodológicamentediseñado como serie de casos, con 23 pacientes operadosen un período de 14 años, de 1987 a 2001.RESULTADOS: La colangitis fue el principal motivo deconsulta en 55% (13) de los pacientes, al ingreso se observóictericia y malestar generalizado en 95% de los pacientes, eldolor y el prurito fueron la segunda manifestación en el77%. La sensibilidad diagnóstica del ultrasonido y latomografía fue mayor al 50%. Las lesiones Bismuth II fueronlas más frecuentes en 39%. Se realizó Hepato-yeyunoanastomosis en el 59%, de los cuales se colocó sonda en Ten el 77% de los pacientes. Otras alternativas utilizadasfueron hepatectomía derecha o izquierda y procedimientode Whipple. En 4 casos sólo se realizó derivación con sondaT o la colocación percutánea de sonda transhepática.El adenocarcinoma no papilar fue la variedad histológicamás frecuente, los estadios avanzados T4 se observaron enun 50% y sólo el 32% tenían un estadio T2. El promedio desupervivencia fue de 7.5 meses (intervalo 0.07 a 22.2).CONCLUSIONES: Los tumores de vías biliares son unaenfermedad poco frecuente, el mayor número de casos sepresentan en etapas avanzadas cuando la cirugía ya noofrece la posibilidad de curación, por tanto, las alternativasquirúrgicas paliativas son de elección para mejorar lacalidad de vida.
Salud en Tabasco. 01/2003;
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ABSTRACT: Bile duct injury is a complex and serious complication whose frequency has not diminished. A bilidigestive anastomosis (Roux-en-Y hepaticojejunostomy) is usually needed after complex injuries. Placement of an anastomotic stent is a matter of debate and to our knowledge there is no study that compares the results between stenting and not stenting the anastomosis.
A retrospective review of medical records of patients operated on for biliary reconstruction after iatrogenic injury.
Tertiary care academic university hospital.
A comparative study was performed of patients operated on between 1995 and 1999, who were referred to our hospital for acute or elective reconstruction of the biliary tract following iatrogenic injury. All patients underwent Roux-en-Y hepaticojejunostomy. The patients were divided into 2 groups: those who underwent Roux-en-Y hepaticojejunostomy with a transanastomotic stent and those who underwent Roux-en-Y hepaticojejunostomy without a transanastomotic stent.
Operative mortality, anastomotic dysfunction, biliary fistula, reoperations, postoperative complications, postoperative liver function tests.
Sixty-three patients with high and complex biliary injuries (Bismuth type III, IV; Strasberg D, E). Thirty-seven cases had reconstruction with the placement of a transanastomotic stent and 26 did not have a stent placed. No operative mortality was observed. The postoperative outcomes of both groups were compared and no differences found. Good results were observed in more than 80% of the patients. Reoperations were more frequent in the nonstented group (15% vs. 5%) and complications were more frequent in the stented group (16% vs. 7%).
Good results are obtained with a Roux-en-Y hepaticojejunostomy after complex injuries. The use of transanastomotic stents has to be selective according to the individual characteristics of each patient and the experience of each surgeon. We recommend their use when unhealthy (ie, ischemic, scarred) and small ducts (<4 mm) are found.
Archives of Surgery 01/2002; 137(1):60-3. · 4.24 Impact Factor
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ABSTRACT: Variceal bleeding remains an important complication in extrahepatic portal vein thrombosis (EPVT). As for portal hypertension due to other etiologies, an elective treatment to decrease the risk of subsequent rebleeding is warranted. The results of the Sugiura-Futagawa procedure (SP) in 38 patients with variceal bleeding secondary to EPVT are reported: 20 women and 18 men, with a mean age of 282 years (SEM). Thirty-seven patients were classified as Child-Pugh class A, and one patient as class B. In terms of diagnosis, 45% of patients had idiopathic EPVT, and 18% had associated hypercoagulability disorders; 52% of patients had associated splenic vein thrombosis. The SP was completed in two surgical stages in 18 patients and in one surgical stage in 14; 6 patients had only the abdominal stage. One patient had mild postoperative encephalopathy, and three patients rebled at long-term follow-up study. There were two operative deaths. Actuarial survival was 70% at 64 months. It is concluded that the SP is an excellent alternative for patients with variceal bleeding secondary to EPVT.La trombosis portal extraheptica sin patologia heptica asociada (TPEH) constituye alrededor del 7% de los casos de hipertensin portal en adultos, y es la causa ms frecuente en el paciente peditrico. Como en otros tipos de hipertensin portal, una de las ms importantes complicaciones en pacientes con TPEH es la hemorragia varicosa, la cual requiere algn tipo de tratamiento electivo. Se informan los resultados de nuestra experiencia con el procedimiento de Sugiura-Futagawa (PSP) en 38 pacientes con hemorragia varicosa secundaria a TPEH. El grupo consiste en 20 mujeres y 18 hombres con edad promedio de 282 aos; 37 pacientes fueron clasificados como Child-Pugh A y uno como B. Se diagnostic TPEH en 40% de los casos y 18% presentaban alteraciones asociadas de hipercoagulabilidad; 40% present trombosis esplnica concomitante. El PSP fue realizado en dos etapas en 18 pacientes y en una en 14; en 6 pacientes se realiz la etapa abdominal solamente. Se registraron dos muertes operatorias. Una paciente present encefalopata postoperatoria leve y tres pacientes desarrollaron sangrado en el seguimiento a largo plazo. La tasa actuarial de sobrevida fue de 70% a los 64 meses.Nuestra conclusin es que el PSP es una excelente alternativa para pacientes con hemorragia varicosa debida a TPEH.L'hmorragie par varices oesophagiennes est une complication importante de la thrombose porte extrahpatique (TPEH). Comme dans d'autres tiologies d'hypertension portale, un traitement lectif, dans le but de prvenir la rcidive hmorragique est souhaitable. Les rsultats de l'intervention de Sugiura-Futagawa (SF) sont rapports chez 38 patients ayant saign en raison d'une TPEH. Il y avait 20 femmes, et 18 hommes dont l'ge moyen tait de 282 ans (Erreur de la moyenne). Parmi eux, 37 tait de grade Child-Pugh A, et 1, de grade Child-Pugh B. Quarante-cinq p. cent des patients avaient une TPEH idiopathique, associe dans 18% des cas une hypercoagulabilit. Une thrombose de la veine splnque a t retroyve chez 52% des patients. L'intervention de SF a t ralise chez 18 patients en deux temps et chez 14 patients en un temps. Le temps abdominal n'a t ralis que chez six patients. Il y a eu deux dcs peropratoires, un cas d'encphalopathie modre et trois patients ont eu une rcidive hmorragique. La survie actuarielle tait de 70% 64 mois. On conclue que l'intervention de SF est une excellente alternative chez le patient ayant prsent une hmorragie par rupture de varices oesophagiennes secondaire une TPEH.
World Journal of Surgery 02/1994; 18(2):246-250. · 2.36 Impact Factor
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ABSTRACT: A variant of bilioenteric anastomosis, laterolateral hepatojejunostomy, is described in which the opened anterior aspect of the common hepatic duct and left hepatic duct is anastomosed to a Roux jejunal limb. This technique is specially designed for thin, injured bile ducts in which a conventional anastomosis is difficult due to the small diameter of the ducts. A wide anastomosis is obtained, leaving the posterior wall as a conduit for bile, ensuring an adequate anastomotic diameter.
Journal of Gastrointestinal Surgery 10(8):1164-9. · 2.83 Impact Factor
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ABSTRACT: 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.
To evaluate the results obtained during last three decades in the management of CDBT in the adult patient.
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.
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.
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.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 56(6):718-25. · 0.42 Impact Factor
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Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 56(4):513-21. · 0.42 Impact Factor
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ABSTRACT: Portal hypertension surgery has evolved widely in the last decades. Since the first surgical shunt was done in 1945 for the treatment of recurrent hemorrhage, many surgical options have been developed including selective shunts, low diameter shunts and extensive devascularization procedures. Many of them have been studied and compared showing their advantages and disadvantages, evolving also their role in the therapeutic armamentarium. Surgery is nowadays a second line treatment option (after b blockers and endoscopic therapy), and it's main indication is for patients whose main and only problem is history of bleeding, with good liver function (Child-Pugh A). For emergency situations it has a very limited role and for primary prophylaxis virtually has also no role. Patients with good liver function, electively operated with portal blood flow preserving procedures are the patients that benefit from surgical treatment. Patients with a bad liver function are better candidates for a liver transplant.
Annals of hepatology: official journal of the Mexican Association of Hepatology 1(4):175-8. · 1.81 Impact Factor
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ABSTRACT: Biliary duct lesions have a prevalence of 0.3-0.6% This prevalence is independent of the learning curve: The present paper evaluated survival and quality of life of patients following operative repair.
In a 12-year period, 180 patients underwent bile duct reconstruction. Of these patients (61 males and 129 females, mean age 39 years), 52% sustained injury during open operation and 42% during laparoscopic procedure. Quality of life was evaluated in the postoperative period.
All 180 patients were treated surgically by means of Roux en Y hepaticojejunostomy. Transhepatic stents were used in 142 patients. Eight patients had independent left and right duct anastomosis and in 51 cases, partial resection of segment IV of liver to improve exposure of hilus was carried out. Mortality was 1.7%, due to multiorganic failure. After removal of stent, radiologic manipulation was required in 16% of cases to remove debris and stones or to dilate anastomosis. A total of 83% of patients were completely rehabilitated both clinically and biochemically.
Bile duct injury has a good prognosis in specialized tertiary-care centers. Roux en Y hepatoyeyunostomy is procedure of choice with trans-hepatic stent when needed. Full rehabilitation can be achieved in 80% of patients.
Revista de gastroenterologia de Mexico 67(4):245-9.
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ABSTRACT: Extensive esophagogastric devascularization (Sugiura-Futagawa operation and complete portoazygos disconnection) are excellent alternate choices for low-risk patients (Child-Pugh A-B) in whom a selective shunt is not feasible, obtaining a low postoperative rebleeding rate and a good quality of life. Esophageal transection is an important step in these procedures because submucosal varices are obliterated, achieving complete portoazygos disconnection. Results during one decade with closed variant of esophageal transection are reported.
Between 1990 and 2000, 78 patients were operated on (69 Child-Pugh A and nine Child Pugh B) in two operative stages with Sugiura-Futagawa operation and complete portoazygos disconnection. Files of these patients were reviewed and recurrence of hemorrhage was evaluated as well as fistulization and dehiscence.
Among 78 modified transections, only one case of dehiscence was observed (1.2%) (very early in our experience) with concomitant mortality. Rebleeding was observed in 11% of cases, with two cases of stenosis that required dilatation. During the last 7 years (57 patients), no complication has been observed.
Modified transection has a very low complication rate with long-term results comparable to those of classic transection.
Revista de gastroenterologia de Mexico 67(3):186-9.
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ABSTRACT: Analyze the experience with pancreaticoduodenectomy (PD) at the INCMNSZ.
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.
The data of all PD's performed at the INCMNSZ between 1999 and 2005 was gathered prospectively and analyzed retrospectively.
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.
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.
Revista de gastroenterologia de Mexico 71(3):252-6.
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ABSTRACT: 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.
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.
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.
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.
Annals of hepatology: official journal of the Mexican Association of Hepatology 5(1):44-8. · 1.81 Impact Factor
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ABSTRACT: 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.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 57(2):262-72. · 0.42 Impact Factor
