Kui Hin Liau

• MBBS, M.Med(Surgery), FRCS, FAMS(Surgery)
• Senior Consultant at Mount Elizabeth Novena

Fischer’s Mastery of Surgery, Seventh Edition Peri-operative Antimicrobial Prophylaxis & Treatment of Surgical Infection Liau Kui Hin, Giorgio Tarchini and Solomkin Joseph ISBN:978-1-46989-718-9, LCCN: 2017041639 Publication Date: 2018 Wolters Kluwer, Inc. Philadelphia

This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our i...

Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. Tokyo Guidelines 2018 (TG 18) provides recommendations for the appropriate for use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy) provided before the infecting i...

Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangiti...

1. Surg Infect (Larchmt). 2017 Nov/Dec;18(8):846-853. doi: 10.1089/sur.2017.219. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. [No authors listed] This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat...

Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagno...

Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines...

Background: Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce. Methods: Surgeons from Japan, Korea, Taiwan, and the U.S., etc....

The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for the definitiv...

Antimicrobial Stewardship in Surgery: Challenges and Opportunities Giorgio Tarchini Kui Hin Liau Joseph S. Solomkin

Regional epidemiological data and resistance profiles are essential for selecting appropriate antibiotic therapy for intra-abdominal infections (IAIs). However, such information may not be readily available in many areas of Asia and current international guidelines on antibiotic therapy for IAIs are for Western countries, with the most recent guida...

Acute biliary infection (acute cholecystitis and acute cholangitis) is one of the common emergency conditions which carries significant morbidity and mortality. The risk factors are often associated with gallstones, biliary stasis and bile infection. Gram-negative bacteria are frequent isolates from bile and blood cultures in infectious cholangitis...

Background: The purpose of the present study was to determine whether intrahepatic injection of (131)I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC). Methods: From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4-...

Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteri...

We propose a management strategy for acute cholangitis and cholecystitis according to the severity assessment. For Grade I (mild) acute cholangitis, initial medical treatment including the use of antimicrobial agents may be sufficient for most cases. For non-responders to initial medical treatment, biliary drainage should be considered. For Grade I...

Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. D...

Therapy with appropriate antimicrobial agents is an important component in the management of patients with acute cholangitis and/or acute cholecystitis. In the updated Tokyo Guidelines (TG13), we recommend antimicrobial agents that are suitable from a global perspective for management of these infections. These recommendations focus primarily on em...

Application of minimally invasive techniques in the surgical management of distal pancreatic lesions is increasing. Despite this, numbers of laparoscopic distal pancreatectomy remain low and limited to treatment of benign and premalignant lesions. Retrospective analysis of 31 patients who underwent distal pancreatectomy from 2005 to 2010. Patients...

Although mortality & morbidity for pancreaticoduodenectomy (PD) have improved significantly over the last two decades, the concern for elderly undergoing PD remains. This study examines the outcome of the elderly patients who had pancreaticoduodenectomy in our institution. A prospective database comprising 69 patients who underwent pancreaticoduode...

Conventionally, patients who failed endoscopic removal of common bile duct stones (CBDS) by endoscopic retrograde cholangiopancreaticography (ERCP) would be treated with open cholecystectomy and common bile duct exploration. Laparoscopic common bile duct exploration (LCBDE) is an established option for treating CBDS. The aim of this paper was to lo...

The International Study Group for Pancreatic Surgery (ISGPS) has proposed several definitions for postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and post-pancreatectomy haemorrhage (PPH). We assessed the effects of implementing these definitions on predicting outcomes. A database of 77 patients who underwent pancreaticoduod...

Hepatolithiasis is a challenging condition to treat especially in patients with previous hepatobiliary surgery. Percutaneous Transhepatic Cholangioscopic Lithotripsy (PTCSL) is an attractive salvage option for the treatment of recurrent hepatolithiasis. We reviewed our experience using PTCSL in treating 4 patients with previous complex abdominal su...

Mesenteric desmoid tumour (MDT) is an uncommon neoplasm that typically presents as a solid soft-tissue mass on cross-sectional imaging. MDT manifesting as a fat-containing cystic mass on CT has not been described in the literature. We report such an unusual case with clinicopathological correlation.

TPS210 Background: The epidermal growth factor receptor (EGFR) pathway may play an important role in the pathogenesis of hepatocellular carcinoma (HCC) as it is expressed in 75% of patients' tumors in contrast to 30% of normal hepatocytes. Gefitinib, an oral tyrosine kinase inhibitor that targets the EGFR, is approved for the treatment of lung canc...

The aim of this study was to conduct an audit of the sensitivity and specificity of ultrasound, fi ne needle aspiration cytology (FNAC) and frozen section in the evaluation of thyroid malignancies in our practice. The medical records of all the patients who underwent thyroid surgery in a tertiary institution's General Surgery Department between Jan...

Surgical site infection (SSI) is a preventable complication. Achieving a zero SSI rate for all clean operations should be the goal of all surgeons. We aimed to reduce our SSI rate by 50% for patients undergoing elective gastrointestinal and hernia operations. The study was conducted in a tertiary-care hospital department of surgery from January 200...

Laparoscopic common bile duct exploration (CBDE) is becoming more popular in the management of choledocholithiasis due to improved laparoscopic expertise and advancement in endoscopic technology and equipment. This study aimed to evaluate the safety and short-term outcome of laparoscopic CBDE in a single institution over a 3-year period. A retrospe...

Cancer such as hepatocellular carcinoma (HCC) is characterized by complex perturbations in multiple signaling pathways, including the phosphoinositide-3-kinase (PI3K/AKT) pathways. Herein we investigated the role of PI3K catalytic isoforms, particularly class II isoforms in HCC proliferation. Among the siRNAs tested against the eight known catalyti...

Tuberculosis (TB) is a worldwide pandemic, and is seeing a resurgence because of the AIDS epidemic. Pancreatic involvement is rare in the world, and when it is isolated around the pancreas, it is often mistaken for pancreatic carcinoma. We report three cases of pancreatic TB that masqueraded as malignancy in a 50-year-old female, a 34-year-old male...

Laparoscopic hepatectomy has been performed in many overseas centres. By avoiding long incisions associated with open hepatectomies, patients suffer less pain, recover faster and enjoy a shorter hospital stay. In Singapore, many centres have recently embarked on this approach. We believe that careful patient selection can facilitate scaling the lea...

Laparoscopic resection for small lesions of the pancreas has recently gained popularity. We report our initial experience with a new approach to laparoscopic spleen-preserving distal pancreatectomy so that the maximum amount of normal pancreas can be preserved while ensuring adequate resection margins and preservation of the spleen and splenic vess...

To determine if the degree of blood loss during resection of hepatocellular carcinoma (HCC) is predictive of recurrence and long-term survival. Several studies have addressed the impact of blood transfusion on survival and recurrence after liver resection for HCC. However, the independent effect of intraoperative estimated blood loss (EBL) on oncol...

Day-Case laparoscopic cholecystectomy (LC) is practiced in many countries. However, this has yet to be widely accepted in Singapore. This study aims to determine the potential success rate of day-case LC in our institution. We retrospectively assessed the proportion of our Ambulatory Surgery 23 hour (AS23) LC patients that met discharge criteria. O...

Pancreaticoduodenectomy (PD), once carried high morbidity and mortality, is now a routine operation performed for lesions arising from the pancreatico-duodenal complex. This study reviews the outcome of 101 pancreaticoduodenectomies performed after formalization of HepatoPancreatoBiliary (HPB) unit in the Department of Surgery. A prospective databa...

Operations on the biliary tract have always been associated with a small risk of bile duct injury. The incidence of these injuries increased with the introduction of laparoscopic cholecystectomy but has now fallen to a rate that appears similar to that of open cholecystectomy. Bile duct injuries can present in at least three ways. The first is the...

Gastrointestinal stromal tumor (GIST) is the most frequent sarcoma of the intestinal tract and often shows constitutive activation of either the KIT or PDGFRA receptor tyrosine kinases because of gain-of-function mutation. Although the efficacy of tyrosine kinase inhibitors in metastatic GIST depends on tumor mutation status, there have been confli...

There are no evidence-based-criteria for the diagnosis, severity assessment, of treatment of acute cholecystitis or acute cholangitis. For example, the full complement of symptoms and signs described as Charcot's triad and as Reynolds' pentad are infrequent and as such do not really assist the clinician with planning management strategies. In view...

The Tokyo Guidelines formulate clinical guidance for healthcare providers regarding the diagnosis, severity assessment, and treatment of acute cholangitis and acute cholecystitis. The Guidelines were developed through a comprehensive literature search and selection of evidence. Recommendations were based on the strength and quality of evidence. Exp...

Diagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute...

Biliary decompression and drainage done in a timely manner is the cornerstone of acute cholangitis treatment. The mortality rate of acute cholangitis was extremely high when no interventional procedures, other than open drainage, were available. At present, endoscopic drainage is the procedure of first choice, in view of its safety and effectivenes...

Because acute cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition t...

Antimicrobial agents should be administered to all patients with suspected acute cholangitis as a priority as soon as possible. Bile cultures should be performed at the earliest opportunity. The important factors which should be considered in selecting antimicrobial therapy include the agent's activity against potentially infecting bacteria, the se...

Biliary drainage is a radical method to relieve cholestasis, a cause of acute cholangitis, and takes a central part in the treatment of acute cholangitis. Emergent drainage is essential for severe cases, whereas patients with moderate and mild disease should also receive drainage as soon as possible if they do not respond to conservative treatment,...

The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addi...

Cholecystectomy has been widely performed in the treatment of acute cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, acute cholecystitis was initially considered a con...

Surgery of the Liver, Biliary Tract and Pancreas, Vol 2, Section 14, Chapter 83;1440-1451, 4th Edition, Elsevier Jan 2007 Segment-oriented Anatomic Liver Resections Liau Kui Hin, Ronald Paul DeMatteo

Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma, has distinct pathologic features, and typically occurs in young patients without underlying hepatitis or cirrhosis. Forty-one patients with the pathologic diagnosis of FL-HCC evaluated at our institution between 1986 and 2003 were identified from a prospe...

Surgical resection for large (> 10 cm) hepatocellular carcinoma (HCC) is believed by many to be ineffective. The objective of the current study was to review the outcome of partial hepatectomy in patients with large HCC. Between 1985 and 2002, 193 consecutive patients who underwent partial hepatectomy for HCC were identified from a prospective data...

Segment-oriented liver resection is a distinct surgical approach and represents the virtuosity of hepatic surgery. It is unique in the finesse of its execution and in its oncologic efficacy and safety. The varied combinations of segmentectomy allow greater flexibility and opportunity for liver surgeons to extirpate the equally diverse nature and lo...

Mirizzi syndrome (MS) is an unusual complication of gallstone disease. The majority of cases are not identified pre-operatively, despite advances in imaging techniques. Eighteen cases of MS were treated between January 1997 and April 2002. The clinical presentation, modes of investigation, surgical management and outcome are retrospectively reviewe...

Hepatolithiasis is an uncommon entity in Singapore. We reviewed the cases presented to our institution (a 1200-bedded restructured hospital) over a 5-year period. Twelve cases of hepatolithiasis were treated between December 1995 and July 2000 representing 0.77% of gallstone disease operated on in the same period. The clinical presentation, investi...

Kapandji described intra-focal pin fixation of distal radial fracture in which the pins pass through the fracture line and anchor to the far cortex. These pins aid reduction of the fracture and maintain reduction by buttressing the distal fragments. Between January 1996 to December 1997, 186 distal radial fractures were treated with intra-focal pin...