I. Barros, É. Mateus, J. S. Coelho, A. Martins, E. Barroso, F. Nolasco, Hugo Pinto-Marques
Domino Liver transplant (DLT) is a strategy to address organ shortage and expand the liver donor pool for liver transplantation. Despite offering some unique technical challenges, DLT appears to be a safe and reasonable option to be considered for selected patients who would otherwise not benefit from liver transplantation. However, the benefit of expanding the donor pool must be balanced against the risk of disease transmission.In this review, we present where the DLT currently stands worldwide and our own experience with this procedure.
{"title":"Domino Liver Transplantation: Current Status","authors":"I. Barros, É. Mateus, J. S. Coelho, A. Martins, E. Barroso, F. Nolasco, Hugo Pinto-Marques","doi":"10.21614/SGO-26-319","DOIUrl":"https://doi.org/10.21614/SGO-26-319","url":null,"abstract":"Domino Liver transplant (DLT) is a strategy to address organ shortage and expand the liver donor pool for liver transplantation. Despite offering some unique technical challenges, DLT appears to be a safe and reasonable option to be considered for selected patients who would otherwise not benefit from liver transplantation. However, the benefit of expanding the donor pool must be balanced against the risk of disease transmission.In this review, we present where the DLT currently stands worldwide and our own experience with this procedure.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81098068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although laparoscopic donor right hepatectomy (LDRH) is increasingly performed in adult living donor liver transplantation, most experiences have been reported from a limited number of major transplant centers. This is because LDRH requires high-level surgical skills and a guarantee of donor safety. Thus, despite its many advantages, this operation program should be performed with caution, especially in less experienced centers. Various surgical techniques and the know-how have been introduced by several publications in recent years, which include donor’s position during operation, selection of port sites and division methods of bile duct and vascular structures. Even though the technical consensus on LDRH has not been established yet, the accumulated experience of major LDRH centers is a good starting point to guide surgeons planning a new LDRH program.
{"title":"Technical Tips in Laparoscopic Donor Right Hepatectomy in Living Donor Liver Transplantation","authors":"Hae Won Lee, Ho-Seong Han, J. Cho","doi":"10.21614/SGO-26-327","DOIUrl":"https://doi.org/10.21614/SGO-26-327","url":null,"abstract":"Although laparoscopic donor right hepatectomy (LDRH) is increasingly performed in adult living donor liver transplantation, most experiences have been reported from a limited number of major transplant centers. This is because LDRH requires high-level surgical skills and a guarantee of donor safety. Thus, despite its many advantages, this operation program should be performed with caution, especially in less experienced centers. Various surgical techniques and the know-how have been introduced by several publications in recent years, which include donor’s position during operation, selection of port sites and division methods of bile duct and vascular structures. Even though the technical consensus on LDRH has not been established yet, the accumulated experience of major LDRH centers is a good starting point to guide surgeons planning a new LDRH program.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89193906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Wahab, A. Sultan, Amr Yasesn, O. Fathi, T. Salah, Mohamed M. Elshobari, M. Elsadany, E. E. Abdel-Khalek, M. Elmorshedi, A. Monir, Mohamed Eldesoky, R. Said, M. M. Emara, M. Abdelkhalek, M. Elsedeiq, Karem Abuzeed, A. Shehta
Introduction: Living-donor liver transplantation (LDLT) is a complex procedure requiring a special perioperative patients’ care. Despite the improvements in the operative techniques and perioperative care, early postoperative mortality remains a disappointing event. The current study is conducted to determine the incidence, causes and potential predictive factors of early postoperative mortality after LDLT. Methods: We reviewed the data of patients who underwent LDLT during the period between May 2004 till October 2020. Results: During the study period, 780 cases underwent LDLT. Early Mortality occurred in 109 cases (14%). We divided our cases into two groups, Early Mortality group (n=109) and Survivors group (n=671). Higher preoperative INR, creatinine, and MELD score were found in Early Mortality group. More blood loss and perioperative transfusions were found in Early Mortality group. Longer ICU stay with higher incidence of pulmonary and vascular complications were found in Early Mortality group. Preoperative MELD score, blood transfusion, pulmonary complications, and vascular complications were significant predictors of early mortality in multivariate analysis. Conclusion: Reduction of perioperative transfusions together with early detection and management of vascular and respiratory complications are essential to reduce early mortality after LDLT.
{"title":"Predictive Factors of Early Mortality after Living Donor Liver Transplantation: A Single Center Experience of 780 Cases over 16 Years","authors":"M. Wahab, A. Sultan, Amr Yasesn, O. Fathi, T. Salah, Mohamed M. Elshobari, M. Elsadany, E. E. Abdel-Khalek, M. Elmorshedi, A. Monir, Mohamed Eldesoky, R. Said, M. M. Emara, M. Abdelkhalek, M. Elsedeiq, Karem Abuzeed, A. Shehta","doi":"10.21614/SGO-26-329","DOIUrl":"https://doi.org/10.21614/SGO-26-329","url":null,"abstract":"Introduction: Living-donor liver transplantation (LDLT) is a complex procedure requiring a special perioperative patients’ care. Despite the improvements in the operative techniques and perioperative care, early postoperative mortality remains a disappointing event. The current study is conducted to determine the incidence, causes and potential predictive factors of early postoperative mortality after LDLT. Methods: We reviewed the data of patients who underwent LDLT during the period between May 2004 till October 2020. Results: During the study period, 780 cases underwent LDLT. Early Mortality occurred in 109 cases (14%). We divided our cases into two groups, Early Mortality group (n=109) and Survivors group (n=671). Higher preoperative INR, creatinine, and MELD score were found in Early Mortality group. More blood loss and perioperative transfusions were found in Early Mortality group. Longer ICU stay with higher incidence of pulmonary and vascular complications were found in Early Mortality group. Preoperative MELD score, blood transfusion, pulmonary complications, and vascular complications were significant predictors of early mortality in multivariate analysis. Conclusion: Reduction of perioperative transfusions together with early detection and management of vascular and respiratory complications are essential to reduce early mortality after LDLT.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73825916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Habeeb, E. Salah, Ahmed S. Mohamed, Said M. Negm
{"title":"Role of Laparoscopic Splenectomy in Isolated High-Grades Splenic Injuries: A Randomized Controlled Trial","authors":"T. Habeeb, E. Salah, Ahmed S. Mohamed, Said M. Negm","doi":"10.21614/sgo-ec-369","DOIUrl":"https://doi.org/10.21614/sgo-ec-369","url":null,"abstract":"","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80480093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bahnasy, Rawhia Hassan El-Edel, Hanaa Mohammed Eid El Sayed, Abd El Naser
Objective: This study was designed to determine the relationship between metabolic syndrome as a risk factor for colorectal cancer. Background: Overweight and obesity are leading risks for global deaths. Although the increase in obesity over the last 35 years has been most dramatic in the US and western industrialized countries, similar trends have also been seen in urban areas of many developing countries. There are multiple common health consequences of an elevated body mass index, including risk for several metabolic disorders, some cancers and ultimately
{"title":"Evaluation of Metabolic Syndrome as A Risk Factor for Colorectal Cancer","authors":"A. Bahnasy, Rawhia Hassan El-Edel, Hanaa Mohammed Eid El Sayed, Abd El Naser","doi":"10.21614/sgo-26-4-420","DOIUrl":"https://doi.org/10.21614/sgo-26-4-420","url":null,"abstract":"Objective: This study was designed to determine the relationship between metabolic syndrome as a risk factor for colorectal cancer. Background: Overweight and obesity are leading risks for global deaths. Although the increase in obesity over the last 35 years has been most dramatic in the US and western industrialized countries, similar trends have also been seen in urban areas of many developing countries. There are multiple common health consequences of an elevated body mass index, including risk for several metabolic disorders, some cancers and ultimately","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82841857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Leş, I. Băncilă, A. Dimitriu, B. Cotruta, I. Pirvulescu, I. Lupescu, R. Iacob, C. Gheorghe
Acute diverticulitis is a frequent complication in patients with colonic diverticulosis. The diagnosis is based on the clinical presentation, biological markers and imaging. Abdominal ultrasonography is, in many centers, the first examination in patients presenting with abdominal pain. Bowel ultrasonography has the advantage of being an inexpensive, non-ionizing, readily available and repeatable examining method, but needs an experienced operator, and it is, thus, not widely used in clinical practice. We present a case series of acute diverticulitis, using bowel ultrasonography to establish the diagnosis in three different clinical settings: uncomplicated diverticulitis, abscess complicated diverticulitis and neoplasia associated diverticulitis. The patients were examined at admission, abdominal pain being the main symptom. The ultrasound examination started with a 3-5 MHz probe as in the case of classic ultrasound, followed by a 5-11 MHz probe examination that allowed adequate investigation of the bowel loops and establishing a diagnosis of acute diverticulitis based on ultrasonographic criteria. All patients had the diagnosis confirmed by a computer tomography scan and subsequently underwent antibiotic treatment. All patients had ultrasonographic characteristics suggesting parietal inflammation, overlapping with the lesions observed at CT scan which were indicative of acute diverticulitis. Both imaging techniques were able to show complications and extraintestinal alterations. Abdominal ultrasound is the imaging method most frequently used in patients presenting with abdominal pain. By using the appropriate transducer, acute diverticulitis and complications could be accurately diagnosed.
{"title":"Bowel Ultrasound for Acute Diverticulitis - Technical Aspects in Three Different Clinical Settings","authors":"A. Leş, I. Băncilă, A. Dimitriu, B. Cotruta, I. Pirvulescu, I. Lupescu, R. Iacob, C. Gheorghe","doi":"10.21614/sgo-26-2-351","DOIUrl":"https://doi.org/10.21614/sgo-26-2-351","url":null,"abstract":"Acute diverticulitis is a frequent complication in patients with colonic diverticulosis. The diagnosis is based on the clinical presentation, biological markers and imaging. Abdominal ultrasonography is, in many centers, the first examination in patients presenting with abdominal pain. Bowel ultrasonography has the advantage of being an inexpensive, non-ionizing, readily available and repeatable examining method, but needs an experienced operator, and it is, thus, not widely used in clinical practice. We present a case series of acute diverticulitis, using bowel ultrasonography to establish the diagnosis in three different clinical settings: uncomplicated diverticulitis, abscess complicated diverticulitis and neoplasia associated diverticulitis. The patients were examined at admission, abdominal pain being the main symptom. The ultrasound examination started with a 3-5 MHz probe as in the case of classic ultrasound, followed by a 5-11 MHz probe examination that allowed adequate investigation of the bowel loops and establishing a diagnosis of acute diverticulitis based on ultrasonographic criteria. All patients had the diagnosis confirmed by a computer tomography scan and subsequently underwent antibiotic treatment. All patients had ultrasonographic characteristics suggesting parietal inflammation, overlapping with the lesions observed at CT scan which were indicative of acute diverticulitis. Both imaging techniques were able to show complications and extraintestinal alterations. Abdominal ultrasound is the imaging method most frequently used in patients presenting with abdominal pain. By using the appropriate transducer, acute diverticulitis and complications could be accurately diagnosed.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80566015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tamer A. A. M., Hatem Mohammad, Mohamed Ibrahim Mansour, Mohamed Farouk Amin
Background: Cholecystectomy is the standard surgical option for symptomatic gallbladder disease. The symptoms persist after cholecystectomy in 10 - 20% of cases. Residual gallbladder/cystic duct stump stone is one of the most important causes. This study aimed to evaluate and compare outcomes of open and laparoscopic completion cholecystectomy for gallbladder (GB) remnant stones and cystic duct stump stones as regards intraoperative and postoperative outcomes. Methods: This study was conducted on 84 cases with residual gallbladder remnant stone or cystic duct stump stone that were divided into 2 groups, the open completion cholecystectomy group (Group A=42 cases) and the laparoscopic completion cholecystectomy group (Group B=42 cases). The diagnosis was made by ultrasound and magnetic resonance cholangio-pancreatography. Results: Operative time (p=0.00) significantly higher at laparoscopic completion cholecystectomy and blood loss (p=0.0026) were significantly associated with open completion cholecystectomy while there was no statistically significant difference between both groups as regards intraoperative biliary injuries (p=0.56). The mean operative time was 120±13 min and 160±10 min in the open group and the laparoscopic group, respectively. 8 cases in the open group and 2 cases in the laparoscopic group showed intraoperative blood loss and required blood transfusion. Intraoperative biliary injuries occurred in 3 cases in the open group and 2 cases in the laparoscopic group. Conversion occurred in 4 cases in the laparoscopic group: 2 cases due to extensive adhesion, 1 case due to uncontrolled bleeding from the cystic artery, and I case from biliary leakage. Hospital stay conversion rate; minimal post-operative complications, namely biliary leakage and bleeding; and shorter hospital stay. Trial registration at clinicaltrials.gov protocol registration quality control review criteria: NCT04329143 registered on 01/04/2020, retrospective registered.
{"title":"Post-Cholecystectomy Gallbladder Remnant and Cystic Duct Stump Stone: Surgical Pitfalls, Causes of Occurrence and Completion Cholecystectomy (Open versus Laparoscopic) as a Safe Surgical Option of Treatment: Short and Long Term Outcome. Randomized Control","authors":"Tamer A. A. M., Hatem Mohammad, Mohamed Ibrahim Mansour, Mohamed Farouk Amin","doi":"10.21614/sgo-ec-368","DOIUrl":"https://doi.org/10.21614/sgo-ec-368","url":null,"abstract":"Background: Cholecystectomy is the standard surgical option for symptomatic gallbladder disease. The symptoms persist after cholecystectomy in 10 - 20% of cases. Residual gallbladder/cystic duct stump stone is one of the most important causes. This study aimed to evaluate and compare outcomes of open and laparoscopic completion cholecystectomy for gallbladder (GB) remnant stones and cystic duct stump stones as regards intraoperative and postoperative outcomes. Methods: This study was conducted on 84 cases with residual gallbladder remnant stone or cystic duct stump stone that were divided into 2 groups, the open completion cholecystectomy group (Group A=42 cases) and the laparoscopic completion cholecystectomy group (Group B=42 cases). The diagnosis was made by ultrasound and magnetic resonance cholangio-pancreatography. Results: Operative time (p=0.00) significantly higher at laparoscopic completion cholecystectomy and blood loss (p=0.0026) were significantly associated with open completion cholecystectomy while there was no statistically significant difference between both groups as regards intraoperative biliary injuries (p=0.56). The mean operative time was 120±13 min and 160±10 min in the open group and the laparoscopic group, respectively. 8 cases in the open group and 2 cases in the laparoscopic group showed intraoperative blood loss and required blood transfusion. Intraoperative biliary injuries occurred in 3 cases in the open group and 2 cases in the laparoscopic group. Conversion occurred in 4 cases in the laparoscopic group: 2 cases due to extensive adhesion, 1 case due to uncontrolled bleeding from the cystic artery, and I case from biliary leakage. Hospital stay conversion rate; minimal post-operative complications, namely biliary leakage and bleeding; and shorter hospital stay. Trial registration at clinicaltrials.gov protocol registration quality control review criteria: NCT04329143 registered on 01/04/2020, retrospective registered.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83709364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liver transplantation is a therapeutic option for acute and chronic end stage liver diseases and certain hepatic malignant tumors. The growing disparity between the number of liver transplant candidates and the supply of deceased donor organs has led the increase living donor liver transplantation (LDLT). The provision of an adequate outflow is indispensable for graft function. In order to meet the metabolic demand of the recipient, the majority of the transplant centers switched to a right lobe from the left lobe LDLT which makes hepatic venous reconstruction more complicated. Additionally, the regenerative process of the hepatic allograft may lead dynamic changes in the spatial orientation of reconstructed blood vessels, especially the hepatic venous outflow. Different technical approaches and algorithms have been developed to prevent graft congestion and to perform a sufficient outflow reconstruction. In this review, several considerations of outflow reconstruction techniques are discussed on the basis of our experience and the literature.
{"title":"Outflow Reconstruction Techniques in Living Donor Liver Transplantation","authors":"E. Dulundu","doi":"10.21614/SGO-26-331","DOIUrl":"https://doi.org/10.21614/SGO-26-331","url":null,"abstract":"Liver transplantation is a therapeutic option for acute and chronic end stage liver diseases and certain hepatic malignant tumors. The growing disparity between the number of liver transplant candidates and the supply of deceased donor organs has led the increase living donor liver transplantation (LDLT). The provision of an adequate outflow is indispensable for graft function. In order to meet the metabolic demand of the recipient, the majority of the transplant centers switched to a right lobe from the left lobe LDLT which makes hepatic venous reconstruction more complicated. Additionally, the regenerative process of the hepatic allograft may lead dynamic changes in the spatial orientation of reconstructed blood vessels, especially the hepatic venous outflow. Different technical approaches and algorithms have been developed to prevent graft congestion and to perform a sufficient outflow reconstruction. In this review, several considerations of outflow reconstruction techniques are discussed on the basis of our experience and the literature.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82522987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andreea Franculescu-Bertea, I. Copaci, L. Iliescu, L. Micu
Background: Circulating cryoglobulins are detected in 40-60% of patients with HCV chronic infection, and cryoglobulinemic vasculitis is observed in 15% of cases. Methods: We included 24 patients with HCV-related mixed cryoglobulinemia (MC) and 8 patients with asymptomatic HCV cryoglobulinemia, between 2016-2019. All patients received DAA therapy: 22 patients with ombitasvir/paritaprevir/ritonavir and dasabuvirand 10 patients with ledipasvir/sofosbuvir. The primary endpoint was complete clinical remission of vasculitis at week 24. Results: All 5 patients with renal involvement received immunosuppressive therapy; complete clinical remission occurred in 3 of these cases. SVR was achieved in 91.6% of patients with vasculitis, compared to 100% in the asymptomatic group (p=0.01). Purpura, myalgia, arthralgia and muscular weakness resolved in 91.6% of patients after SVR. Neurological symptoms improved in 75% of cases. All immunological parameters improved after therapy. Circulating cryoglobulins became undetectable in 54.2% of patients with vasculitis and in 62.4% of the asymptomatic group. The predictive factors for clinical and immunological response were: level of fibrosis, cryocrit and C4 levels, rheumatoid factor activity, and BVASv3. Conclusions: Direct antiviral therapy generates a virological response of over 95% in patients with HCV cryoglobulinemic vasculitis, and is associated with increased rates of complete clinical response and moderate immunological response.
{"title":"Evolution of HCV-Associated Cryoglobulinemic Vasculitis after Treatment with Direct-Acting Antivirals","authors":"Andreea Franculescu-Bertea, I. Copaci, L. Iliescu, L. Micu","doi":"10.21614/sgo-26-4-373","DOIUrl":"https://doi.org/10.21614/sgo-26-4-373","url":null,"abstract":"Background: Circulating cryoglobulins are detected in 40-60% of patients with HCV chronic infection, and cryoglobulinemic vasculitis is observed in 15% of cases. Methods: We included 24 patients with HCV-related mixed cryoglobulinemia (MC) and 8 patients with asymptomatic HCV cryoglobulinemia, between 2016-2019. All patients received DAA therapy: 22 patients with ombitasvir/paritaprevir/ritonavir and dasabuvirand 10 patients with ledipasvir/sofosbuvir. The primary endpoint was complete clinical remission of vasculitis at week 24. Results: All 5 patients with renal involvement received immunosuppressive therapy; complete clinical remission occurred in 3 of these cases. SVR was achieved in 91.6% of patients with vasculitis, compared to 100% in the asymptomatic group (p=0.01). Purpura, myalgia, arthralgia and muscular weakness resolved in 91.6% of patients after SVR. Neurological symptoms improved in 75% of cases. All immunological parameters improved after therapy. Circulating cryoglobulins became undetectable in 54.2% of patients with vasculitis and in 62.4% of the asymptomatic group. The predictive factors for clinical and immunological response were: level of fibrosis, cryocrit and C4 levels, rheumatoid factor activity, and BVASv3. Conclusions: Direct antiviral therapy generates a virological response of over 95% in patients with HCV cryoglobulinemic vasculitis, and is associated with increased rates of complete clinical response and moderate immunological response.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87831085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Clips are commonly used to divide vessels in laparoscopic surgery. However, branches of the superior mesenteric vein (SMV), including the superior right colic vein (SRCV), are narrow, and the clips are too large to be used for these veins. During surgery, there is concern about the risk of bleeding due to vascular injury, as well as when detaching the clips after the procedure. Patients and Methods: From January 2014 to December 2016, six patients with right side transverse colon cancer underwent clipless laparoscopic surgery were enrolled in this study. After skeletonizing around the roots of the SRCVs, they were divided at their roots only by LigaSure, without the use of clips. Results: The mean operative time was 136 min (range 114-160), the mean operative blood loss was less than 10 ml, and no bleeding at the stump of the SRCV was confirmed during surgery. The mean length of hospitalization after surgery was 10 days, and no complications were encountered after surgery. No recurrence was found more than three years after surgery. Conclusion: Clipless laparoscopic division of the SRCV is a useful procedure for patients with right side transverse colon cancer. the superior colic the are to for the of due to vascular injury, when the clips after the procedure; a clipless We performed a novel procedure: a clipless laparoscopic partial colectomy for right side transverse colon cancer.
{"title":"Usefulness of Clipless Laparoscopic Division of Superior Right Colic Vein for Right Side Transverse Colon Cancer","authors":"Hidejiro Kawahara, N. Omura, T. Akiba","doi":"10.21614/sgo-26-4-286","DOIUrl":"https://doi.org/10.21614/sgo-26-4-286","url":null,"abstract":"Background: Clips are commonly used to divide vessels in laparoscopic surgery. However, branches of the superior mesenteric vein (SMV), including the superior right colic vein (SRCV), are narrow, and the clips are too large to be used for these veins. During surgery, there is concern about the risk of bleeding due to vascular injury, as well as when detaching the clips after the procedure. Patients and Methods: From January 2014 to December 2016, six patients with right side transverse colon cancer underwent clipless laparoscopic surgery were enrolled in this study. After skeletonizing around the roots of the SRCVs, they were divided at their roots only by LigaSure, without the use of clips. Results: The mean operative time was 136 min (range 114-160), the mean operative blood loss was less than 10 ml, and no bleeding at the stump of the SRCV was confirmed during surgery. The mean length of hospitalization after surgery was 10 days, and no complications were encountered after surgery. No recurrence was found more than three years after surgery. Conclusion: Clipless laparoscopic division of the SRCV is a useful procedure for patients with right side transverse colon cancer. the superior colic the are to for the of due to vascular injury, when the clips after the procedure; a clipless We performed a novel procedure: a clipless laparoscopic partial colectomy for right side transverse colon cancer.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80343418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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