Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-21-30
V. V. Borovik, I. I. Tileubergenov, O. V. Polukhina, D. A. Granov
Aim . To study the influence of infectious complications on the outcomes of orthotopic liver transplantation. Materials and methods . The methodology involved analyzing the outcomes of 159 orthotopic transplantations of full postmortem liver for 2013–2022. Surgical complications were classified according to Clavien-Dindo (2004). Special attention was paid to microbiological examination of biological fluids with determination of the pathogen species and susceptibility to antimicrobial agents. Determination of isolated cultures and sensitivity to antibacterial agents was carried out using automatic analyzers. Sensitivity and resistance to antimicrobials were determined according to the recommendations of the European Committee (EUCAST, www.eucast.org). Results . At present, 78 of 141 recipients are alive. After discharge, 42 died of various causes within 4–124 months. In-hospital mortality was 9.9% after primary liver transplantations and 38.9% after retransplantations. Recently, K. pneumoniae (18.8%), E. coli (18.7%), C. albicans (9.7%) have dominated the pathogen spectrum. In microbiological examination, after primary transplantation, pathogens were more often isolated from the wound discharge, after retransplantation – from the biliary system. Conclusion . Infectious complications remain a significant cause of unsatisfactory outcomes of liver transplantation. The greatest negative prognostic role belongs to biliary infection caused by multidrug-resistant pathogens in combination with insufficient arterial blood supply of the transplant.
{"title":"Infectious complications as prognostic factors for negative outcomes of liver transplantation","authors":"V. V. Borovik, I. I. Tileubergenov, O. V. Polukhina, D. A. Granov","doi":"10.16931/1995-5464.2023-3-21-30","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-21-30","url":null,"abstract":"Aim . To study the influence of infectious complications on the outcomes of orthotopic liver transplantation. Materials and methods . The methodology involved analyzing the outcomes of 159 orthotopic transplantations of full postmortem liver for 2013–2022. Surgical complications were classified according to Clavien-Dindo (2004). Special attention was paid to microbiological examination of biological fluids with determination of the pathogen species and susceptibility to antimicrobial agents. Determination of isolated cultures and sensitivity to antibacterial agents was carried out using automatic analyzers. Sensitivity and resistance to antimicrobials were determined according to the recommendations of the European Committee (EUCAST, www.eucast.org). Results . At present, 78 of 141 recipients are alive. After discharge, 42 died of various causes within 4–124 months. In-hospital mortality was 9.9% after primary liver transplantations and 38.9% after retransplantations. Recently, K. pneumoniae (18.8%), E. coli (18.7%), C. albicans (9.7%) have dominated the pathogen spectrum. In microbiological examination, after primary transplantation, pathogens were more often isolated from the wound discharge, after retransplantation – from the biliary system. Conclusion . Infectious complications remain a significant cause of unsatisfactory outcomes of liver transplantation. The greatest negative prognostic role belongs to biliary infection caused by multidrug-resistant pathogens in combination with insufficient arterial blood supply of the transplant.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237426","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-65-74
A. E. Kotovskiy, K. G. Glebov, B. M. Magomedova, I. E. Onnicev, M. A. Hokonov, A. S. Prividentseva, A. K. Mahmudova, T. M. Milyushkova, V. V. Pershin, A. M. Hokonov
Aim . To study the reasons for stone migration from the gallbladder into the main bile ducts after endoscopic lithoextraction and to develop methods for preventing recurrent mechanical jaundice before performing the cholecystectomy. Material and methods . Delayed cholecystectomy was recommended for 328 patients with calculous cholecystitis and mechanical jaundice after endoscopic papillosphincterotomy, lithoextraction and restoration of adequate bile outflow. 23 patients were readmitted to hospital with recurrent mechanical jaundice caused by recurrent choledocholithiasis. All patients underwent duodenoscopy, endoscopic retrograde cholangiography and lithoextraction within 12 hours after admission. The size of the gallstones, the diameter of the cystic duct, the level of its insertion into the common hepatic duct, and the length of the previously performed papillotomy were considered as possible causes of recurrent choledocholithiasis. Results . Multiple gallstones of 2–4 mm and low cystic duct insertion into the common hepatic duct were detected in all 23 patients. An increase in the diameter of the cystic duct >5 mm was revealed in 18 patients. In 10 patients, the initial papillotomy was <8 mm. Conclusion . The factors predisposing to recurrent mechanical jaundice due to migration of gallstones into the bile duct and indications for its stenting after lithoextraction before cholecystectomy are ultrasound signs of multiple small gallstones, low insertion the dilated cystic duct into the bile duct, and partial, non-extended papillotomy.
{"title":"Endoscopic stenting of bile ducts for preventing mechanical jaundice recurrence in gallstone migration","authors":"A. E. Kotovskiy, K. G. Glebov, B. M. Magomedova, I. E. Onnicev, M. A. Hokonov, A. S. Prividentseva, A. K. Mahmudova, T. M. Milyushkova, V. V. Pershin, A. M. Hokonov","doi":"10.16931/1995-5464.2023-3-65-74","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-65-74","url":null,"abstract":"Aim . To study the reasons for stone migration from the gallbladder into the main bile ducts after endoscopic lithoextraction and to develop methods for preventing recurrent mechanical jaundice before performing the cholecystectomy. Material and methods . Delayed cholecystectomy was recommended for 328 patients with calculous cholecystitis and mechanical jaundice after endoscopic papillosphincterotomy, lithoextraction and restoration of adequate bile outflow. 23 patients were readmitted to hospital with recurrent mechanical jaundice caused by recurrent choledocholithiasis. All patients underwent duodenoscopy, endoscopic retrograde cholangiography and lithoextraction within 12 hours after admission. The size of the gallstones, the diameter of the cystic duct, the level of its insertion into the common hepatic duct, and the length of the previously performed papillotomy were considered as possible causes of recurrent choledocholithiasis. Results . Multiple gallstones of 2–4 mm and low cystic duct insertion into the common hepatic duct were detected in all 23 patients. An increase in the diameter of the cystic duct >5 mm was revealed in 18 patients. In 10 patients, the initial papillotomy was <8 mm. Conclusion . The factors predisposing to recurrent mechanical jaundice due to migration of gallstones into the bile duct and indications for its stenting after lithoextraction before cholecystectomy are ultrasound signs of multiple small gallstones, low insertion the dilated cystic duct into the bile duct, and partial, non-extended papillotomy.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237563","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-10-20
A. E. Shcherba, L. L. Kuzmenkova, D. Ju. Efimov, A. V. Nosik, P. S. Prilutsky, S. V. Korotkov, A. M. Dzyadzko, O. O. Rummo
Aim . To conduct a systems analysis of clinical and epidemiological risk factors of bacterial complications associated with liver transplantation, to evaluate the effectiveness of their prevention algorithm. Materials and methods . The authors analyzed the treatment outcomes of 1000 recipients who underwent liver transplantation from April 2008 to April 2023. The study involved analysis of correlation between infections associated with health care and main risk factors, including contamination of different loci and preservation solution. Results . The incidence of healthcare-associated infections accounted for 22.2%. The cumulative incidence of donor organ and recipient contamination was 9.85%. Transmission of infection occurred in 29% of cases. Sepsis developed in 8% of all recipients with healthcare-associated infection. The mortality rate was 70% in cases of sepsis. After liver transplantation, in-hospital mortality was 9.3%. Urgent transplantation was required in 10.7% of observations. Univariate regression analysis shows the highest risk contribution to healthcare-associated infection for the MELD score, contamination of preservation solution with multidrug-resistant flora, severe early graft dysfunction, blood loss, and warm ischemia time. Conclusion . Contamination of preservation solution increases the risk of bacterial complications associated with liver transplantation. The resistance profile affects the development time, structure and outcome of these complications. Timely diagnosis and infection control measures are fundamental to preventing the infectious complications.
{"title":"Risk factors and prediction of bacterial complications in liver transplantation","authors":"A. E. Shcherba, L. L. Kuzmenkova, D. Ju. Efimov, A. V. Nosik, P. S. Prilutsky, S. V. Korotkov, A. M. Dzyadzko, O. O. Rummo","doi":"10.16931/1995-5464.2023-3-10-20","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-10-20","url":null,"abstract":"Aim . To conduct a systems analysis of clinical and epidemiological risk factors of bacterial complications associated with liver transplantation, to evaluate the effectiveness of their prevention algorithm. Materials and methods . The authors analyzed the treatment outcomes of 1000 recipients who underwent liver transplantation from April 2008 to April 2023. The study involved analysis of correlation between infections associated with health care and main risk factors, including contamination of different loci and preservation solution. Results . The incidence of healthcare-associated infections accounted for 22.2%. The cumulative incidence of donor organ and recipient contamination was 9.85%. Transmission of infection occurred in 29% of cases. Sepsis developed in 8% of all recipients with healthcare-associated infection. The mortality rate was 70% in cases of sepsis. After liver transplantation, in-hospital mortality was 9.3%. Urgent transplantation was required in 10.7% of observations. Univariate regression analysis shows the highest risk contribution to healthcare-associated infection for the MELD score, contamination of preservation solution with multidrug-resistant flora, severe early graft dysfunction, blood loss, and warm ischemia time. Conclusion . Contamination of preservation solution increases the risk of bacterial complications associated with liver transplantation. The resistance profile affects the development time, structure and outcome of these complications. Timely diagnosis and infection control measures are fundamental to preventing the infectious complications.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237423","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-94-100
S. V. Morozov, V. B. Rumyantsev, A. I. Lobakov, A. N. Shcherbyuk, P. B. Flegontov
The paper presents two clinical observations of successful duodenum-preserving pancreatic head resection performed for chronic calcifying pancreatitis complicated by ductal hypertension. At the reconstructive stage, an isolated segment of jejunum, 20 cm from the ligament of Treitz, was used. It was placed behind the colon. The patients had pancreatojejunostomosis formed with the wound surface of the pancreatic head and duct, and duodenojejunostomosis with the lower horizontal part of the duodenum. The first patient had no complications in the postoperative period. After 6 months, the patient showed improvement in the external secretory function of the pancreas, with absence of pain syndrome. The second patient developed gastrointestinal bleeding on day 10 and underwent endoscopic hemostasis. In 1.5, the esophagogastroduodenoscopy revealed patent anastomosis, without signs of inflammation. The applied variant of surgery enables pancreatic juice to be secreted as close to anatomical and physiological conditions as possible. Furthermore, the method allows endoscopic hemostasis to be performed in case of bleeding from the anastomosis zone. Further study is required on the long-term results of the proposed option of surgery.
{"title":"Option of isolated pancreatic head resection in chronic pancreatitis","authors":"S. V. Morozov, V. B. Rumyantsev, A. I. Lobakov, A. N. Shcherbyuk, P. B. Flegontov","doi":"10.16931/1995-5464.2023-3-94-100","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-94-100","url":null,"abstract":"The paper presents two clinical observations of successful duodenum-preserving pancreatic head resection performed for chronic calcifying pancreatitis complicated by ductal hypertension. At the reconstructive stage, an isolated segment of jejunum, 20 cm from the ligament of Treitz, was used. It was placed behind the colon. The patients had pancreatojejunostomosis formed with the wound surface of the pancreatic head and duct, and duodenojejunostomosis with the lower horizontal part of the duodenum. The first patient had no complications in the postoperative period. After 6 months, the patient showed improvement in the external secretory function of the pancreas, with absence of pain syndrome. The second patient developed gastrointestinal bleeding on day 10 and underwent endoscopic hemostasis. In 1.5, the esophagogastroduodenoscopy revealed patent anastomosis, without signs of inflammation. The applied variant of surgery enables pancreatic juice to be secreted as close to anatomical and physiological conditions as possible. Furthermore, the method allows endoscopic hemostasis to be performed in case of bleeding from the anastomosis zone. Further study is required on the long-term results of the proposed option of surgery.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237568","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-86-93
M. K. Yagudin
The study involved literature review of history and current state of surgical treatment in extrahepatic portal hypertension in children and adults. The author analyzed Russian and foreign publications on surgical repair of hepatopetal blood flow in extrahepatic portal hypertension. The issue is a high priority in Russia, which is confirmed by the fact that the author found out the pioneer studies of Russian authors, which were published earlier than the works of foreign researchers. It was found that the role of hepatopetal blood flow restoration in extrahepatic portal hypertension in adults had been much less studied than in children. More clinical material is to be gathered to determine the feasibility of such interventions in adults.
{"title":"Liver reportalization in extrahepatic portal hypertension","authors":"M. K. Yagudin","doi":"10.16931/1995-5464.2023-3-86-93","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-86-93","url":null,"abstract":"The study involved literature review of history and current state of surgical treatment in extrahepatic portal hypertension in children and adults. The author analyzed Russian and foreign publications on surgical repair of hepatopetal blood flow in extrahepatic portal hypertension. The issue is a high priority in Russia, which is confirmed by the fact that the author found out the pioneer studies of Russian authors, which were published earlier than the works of foreign researchers. It was found that the role of hepatopetal blood flow restoration in extrahepatic portal hypertension in adults had been much less studied than in children. More clinical material is to be gathered to determine the feasibility of such interventions in adults.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237100","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-56-64
M. V. Timerbulatov, R. A. Yamalov, Sh. V. Timerbulatov, L. N. Kakaullina, R. M. Garipov, A. R. Gafarova, V. M. Timerbulatov, R. R. Garaev
Aim . To study the potential of ultrasound examination for assessment of pathomorphological changes in the gallbladder wall according to A1 and A2 criteria and severity of acute cholecystitis (G1-G3 score). Materials and methods . The authors analyzed the results of examination and treatment of 556 patients with acute cholecystitis for the last 2 years. The study involved clinical, laboratory and ultrasound results, their coincidence with the results of histological examination of the removed gallbladder. Results . Clinical and laboratory data coincided with histopathological data in G1 in 84.9% of cases, G2 – in 74.5%, G3 – in 63.2%; ultrasound findings coincided with histopathological data in A1 in 81.54% of cases, in A2 – in 86.59%. The incidence of postoperative complications in G1 comprised 4.6%, in G2 – 8.4%, in G3 – 32.1%, in A1 – 6.8%, and in A2 – 27.7%. Fatal outcomes appeared only in G3 (3.77%) and A2 (2.12%) patients, the overall postoperative mortality was 0.42% and the incidence of postoperative complications was 10.94%. Conclusion . Ultrasound examination in 86.6% of patients with acute cholecystitis enables pathomorphological changes in the gallbladder wall to be evaluated, which significantly facilitates decision making about the timing and extent of surgical intervention.
{"title":"Non-invasive assessment of destructive changes in the gallbladder and severity of acute cholecystitis","authors":"M. V. Timerbulatov, R. A. Yamalov, Sh. V. Timerbulatov, L. N. Kakaullina, R. M. Garipov, A. R. Gafarova, V. M. Timerbulatov, R. R. Garaev","doi":"10.16931/1995-5464.2023-3-56-64","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-56-64","url":null,"abstract":"Aim . To study the potential of ultrasound examination for assessment of pathomorphological changes in the gallbladder wall according to A1 and A2 criteria and severity of acute cholecystitis (G1-G3 score). Materials and methods . The authors analyzed the results of examination and treatment of 556 patients with acute cholecystitis for the last 2 years. The study involved clinical, laboratory and ultrasound results, their coincidence with the results of histological examination of the removed gallbladder. Results . Clinical and laboratory data coincided with histopathological data in G1 in 84.9% of cases, G2 – in 74.5%, G3 – in 63.2%; ultrasound findings coincided with histopathological data in A1 in 81.54% of cases, in A2 – in 86.59%. The incidence of postoperative complications in G1 comprised 4.6%, in G2 – 8.4%, in G3 – 32.1%, in A1 – 6.8%, and in A2 – 27.7%. Fatal outcomes appeared only in G3 (3.77%) and A2 (2.12%) patients, the overall postoperative mortality was 0.42% and the incidence of postoperative complications was 10.94%. Conclusion . Ultrasound examination in 86.6% of patients with acute cholecystitis enables pathomorphological changes in the gallbladder wall to be evaluated, which significantly facilitates decision making about the timing and extent of surgical intervention.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237422","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-101-111
T. Sh. Morgoshiia, N. Yu. Kohanenko, A. A. Kashintsev, O. G. Vavilova, Yu. N. Ulyanov, S. A. Danilov
The paper presents the evolution of views on the surgery of portal hypertension, as well as some historical aspects of its development. The authors considered the main types of surgical interventions to be performed in this pathology. It is noted that in the middle of the 20th century, the direct portacaval anastomosis gained the widest acceptance of all the proposed types of vascular anastomoses. A number of surgeons considered it a classical method of treatment in portal hypertension. Thereafter, the indirect portacaval anastomosis proved to have the best outcomes. The advantage of portacaval anastomoses in comparison with other modifications of surgeries was substantiated by a significant decrease in portal pressure and disappearance of oesophageal varices after developing the anastomosis. Surgical treatment of patients with liver cirrhosis and portal system thrombosis reasonably requires closer attention of doctors in various fields. Such patients should be managed in specialized clinics and well-equipped medical centers.
{"title":"Historical aspects of portal hypertension surgery: evolution of thinking","authors":"T. Sh. Morgoshiia, N. Yu. Kohanenko, A. A. Kashintsev, O. G. Vavilova, Yu. N. Ulyanov, S. A. Danilov","doi":"10.16931/1995-5464.2023-3-101-111","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-101-111","url":null,"abstract":"The paper presents the evolution of views on the surgery of portal hypertension, as well as some historical aspects of its development. The authors considered the main types of surgical interventions to be performed in this pathology. It is noted that in the middle of the 20th century, the direct portacaval anastomosis gained the widest acceptance of all the proposed types of vascular anastomoses. A number of surgeons considered it a classical method of treatment in portal hypertension. Thereafter, the indirect portacaval anastomosis proved to have the best outcomes. The advantage of portacaval anastomoses in comparison with other modifications of surgeries was substantiated by a significant decrease in portal pressure and disappearance of oesophageal varices after developing the anastomosis. Surgical treatment of patients with liver cirrhosis and portal system thrombosis reasonably requires closer attention of doctors in various fields. Such patients should be managed in specialized clinics and well-equipped medical centers.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237425","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-39-47
D. V. Podluzhnyi, Yu. I. Patyutko, A. G. Kotelnikov, I. V. Sagaydak, N. E. Kudashkin, A. N. Polyakov, B. I. Sakibov, N. A. Peregudov, K. A. Romanova, O. A. Egenov
Aim . To evaluate the immediate and long-term results of two-stage liver resection performed by means of ALPPS technique. Materials and methods . The retrospective analysis involved 7 patients (mean age 62 years) with intact liver parenchyma volume (Future Liver Remnant, FLR) <25%. All patients underwent ALPPS from 2014 to 2021. Both stages of ALPPS were performed in the traditional way. The increment of intact parenchyma on days 6–8 after stage I was evaluated by CT volumetry. The main operative characteristics, incidence of postoperative complications according to Clavien-Dindo and ISGLS, time without progression and life expectancy were analyzed. Results . The median duration of ALPPS stage I was 250 min, median blood loss was 600 ml, and stage II – 210 min and 300 ml, correspondingly. The median FLR before and after ALPPS stage I was 15.3% and 31.6%. The median FLR hypertrophy after ALPPS stage I accounted for 123%. The median interval between stage I and II of ALPPS was 10 days. All patients underwent R0 resection. The incidence of postoperative complications after ALPPS stage I was 14.3% (Clavien–Dindo I), after stage II – 57.1% (Clavien–Dindo III–V). The mortality rate within 90 days after ALPPS stage II accounted for 14.3%. Median follow-up was 25 months. The median time without progression in 6 patients operated for colorectal cancer metastases was 6 months, the median life expectancy was 31 months. The patient who underwent ALPPS for hepatocellular carcinoma is alive, no signs of disease progression have been detected. Conclusion . ALPPS provides a rapid and more than two-fold growth in FLR and increases the likelihood of R0 resection in patients with initially unresectable primary and secondary liver tumors. However, the immediate results of ALPPS are unsatisfactory. The indications for surgery are extremely controversial due to the development of drug therapies, ablation techniques and radiotherapy.
{"title":"ALPPS technique for two-stage liver resections: immediate and long-term results","authors":"D. V. Podluzhnyi, Yu. I. Patyutko, A. G. Kotelnikov, I. V. Sagaydak, N. E. Kudashkin, A. N. Polyakov, B. I. Sakibov, N. A. Peregudov, K. A. Romanova, O. A. Egenov","doi":"10.16931/1995-5464.2023-3-39-47","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-39-47","url":null,"abstract":"Aim . To evaluate the immediate and long-term results of two-stage liver resection performed by means of ALPPS technique. Materials and methods . The retrospective analysis involved 7 patients (mean age 62 years) with intact liver parenchyma volume (Future Liver Remnant, FLR) <25%. All patients underwent ALPPS from 2014 to 2021. Both stages of ALPPS were performed in the traditional way. The increment of intact parenchyma on days 6–8 after stage I was evaluated by CT volumetry. The main operative characteristics, incidence of postoperative complications according to Clavien-Dindo and ISGLS, time without progression and life expectancy were analyzed. Results . The median duration of ALPPS stage I was 250 min, median blood loss was 600 ml, and stage II – 210 min and 300 ml, correspondingly. The median FLR before and after ALPPS stage I was 15.3% and 31.6%. The median FLR hypertrophy after ALPPS stage I accounted for 123%. The median interval between stage I and II of ALPPS was 10 days. All patients underwent R0 resection. The incidence of postoperative complications after ALPPS stage I was 14.3% (Clavien–Dindo I), after stage II – 57.1% (Clavien–Dindo III–V). The mortality rate within 90 days after ALPPS stage II accounted for 14.3%. Median follow-up was 25 months. The median time without progression in 6 patients operated for colorectal cancer metastases was 6 months, the median life expectancy was 31 months. The patient who underwent ALPPS for hepatocellular carcinoma is alive, no signs of disease progression have been detected. Conclusion . ALPPS provides a rapid and more than two-fold growth in FLR and increases the likelihood of R0 resection in patients with initially unresectable primary and secondary liver tumors. However, the immediate results of ALPPS are unsatisfactory. The indications for surgery are extremely controversial due to the development of drug therapies, ablation techniques and radiotherapy.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237277","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-31-38
N. G. Sapronova, D. S. Kalinin, E. V. Kosovtsev, Yu. V. Khoronko, D. V. Stagniev, E. Yu. Khoronko, R. E. Kosovtsev
Aim . To improve the outcomes of surgical treatment of patients with cirrhosis complicated by clinically significant portal hypertension by performing TIPS with selective embolization of gastric veins. Materials and methods . The authors explored the immediate and long-term outcomes of treatment of 62 patients with liver cirrhosis: group I included 27 patients who underwent TIPS with selective embolization of one left gastric vein; group II included 35 patients who underwent TIPS with selective embolization of ≥2 gastric veins. The authors tested a non-invasive method for predicting the risk of bleeding from gastric and oesophageal varices after TIPS with selective embolization of gastric veins and compared MRI and EGD results before and after the surgery ( n = 14). Results . The maximum follow-up duration comprised 72 months. Bleeding from the oesophageal veins was not reported in the early period after TIPS with embolization of the left gastric vein, however, the long-term bleeding developed in 2 patients (7.4%). In 6–72 months following TIPS with embolization of the left gastric vein and posterior gastric vein, as well as short gastric veins (when indicated), no recurrences of variceal bleeding appeared. The method of predicting the risk of bleeding after TIPS proved to be effective in all 14 patients in the follow-up period of 6 months (invention application No. 2022129022). Conclusion . The obtained results confirmed the efficacy of TIPS combined with gastric vein embolization. The unique patent solution determined the technique, indications and peculiarities of the intervention.
{"title":"Results of transjugular intrahepatic portosystemic shunt combined with selective gastric vein embolization","authors":"N. G. Sapronova, D. S. Kalinin, E. V. Kosovtsev, Yu. V. Khoronko, D. V. Stagniev, E. Yu. Khoronko, R. E. Kosovtsev","doi":"10.16931/1995-5464.2023-3-31-38","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-31-38","url":null,"abstract":"Aim . To improve the outcomes of surgical treatment of patients with cirrhosis complicated by clinically significant portal hypertension by performing TIPS with selective embolization of gastric veins. Materials and methods . The authors explored the immediate and long-term outcomes of treatment of 62 patients with liver cirrhosis: group I included 27 patients who underwent TIPS with selective embolization of one left gastric vein; group II included 35 patients who underwent TIPS with selective embolization of ≥2 gastric veins. The authors tested a non-invasive method for predicting the risk of bleeding from gastric and oesophageal varices after TIPS with selective embolization of gastric veins and compared MRI and EGD results before and after the surgery ( n = 14). Results . The maximum follow-up duration comprised 72 months. Bleeding from the oesophageal veins was not reported in the early period after TIPS with embolization of the left gastric vein, however, the long-term bleeding developed in 2 patients (7.4%). In 6–72 months following TIPS with embolization of the left gastric vein and posterior gastric vein, as well as short gastric veins (when indicated), no recurrences of variceal bleeding appeared. The method of predicting the risk of bleeding after TIPS proved to be effective in all 14 patients in the follow-up period of 6 months (invention application No. 2022129022). Conclusion . The obtained results confirmed the efficacy of TIPS combined with gastric vein embolization. The unique patent solution determined the technique, indications and peculiarities of the intervention.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"145 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237438","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}
Pub Date : 2023-09-21DOI: 10.16931/1995-5464.2023-3-48-55
A. V. Shabunin, V. V. Bedin, M. M. Tavobilov, A. A. Karpov, A. V. Karalkin, E. I. Vasilenko, K. A. Abramov, A. V. Lantsynova
Aim . To improve the outcomes of pancreaticoduodenal resection by determining the optimal reconstruction based on objective assessment of the functional state of the upper gastrointestinal tract using a modified “double” scintigraphic study. Materials and methods . 147 pancreaticoduodenal resections were performed in the period of 2016–2022. Patients underwent “double” scintigraphic study on days 30 and 90 after surgery. The mean age of the patients was 59.6 years (23–83); the male to female ratio was 1.27:1. All patients underwent gastropancreatoduodenal resection or pancreatoduodenal resection with pylorus preservation. The patients were divided into 3 groups according to the variant of the reconstructive stage of surgery. Group 1 underwent reconstruction according to Child, group 2 – Child reconstruction and interintestinal anastomosis formation according to Brown, the reconstructive stage in group 3 involved Roux-en-Y isolation of the small intestine (Roux-en-Y reconstruction). Results . “Double” scintigraphic study revealed that the best result on the 30th and 90th postoperative days was observed in patients who underwent pancreaticoduodenal resection with pylorus preservation, reconstructive stage according to Child and formation of interintestinal anastomosis after Brown. Conclusion . “Double” scintigraphy is an effective procedure to determine the motility of the stomach, biliodigestive anastomosis and motility of the small intestine. As a result, the optimal reconstruction after pancreaticoduodenal resection was determined in patients with neoplasms of the pancreatic head or the periampullary region and chronic pancreatitis.
{"title":"Determination of the optimal reconstruction for pancreaticoduodenal resection based on modified scintigraphy of gastrointestinal motility","authors":"A. V. Shabunin, V. V. Bedin, M. M. Tavobilov, A. A. Karpov, A. V. Karalkin, E. I. Vasilenko, K. A. Abramov, A. V. Lantsynova","doi":"10.16931/1995-5464.2023-3-48-55","DOIUrl":"https://doi.org/10.16931/1995-5464.2023-3-48-55","url":null,"abstract":"Aim . To improve the outcomes of pancreaticoduodenal resection by determining the optimal reconstruction based on objective assessment of the functional state of the upper gastrointestinal tract using a modified “double” scintigraphic study. Materials and methods . 147 pancreaticoduodenal resections were performed in the period of 2016–2022. Patients underwent “double” scintigraphic study on days 30 and 90 after surgery. The mean age of the patients was 59.6 years (23–83); the male to female ratio was 1.27:1. All patients underwent gastropancreatoduodenal resection or pancreatoduodenal resection with pylorus preservation. The patients were divided into 3 groups according to the variant of the reconstructive stage of surgery. Group 1 underwent reconstruction according to Child, group 2 – Child reconstruction and interintestinal anastomosis formation according to Brown, the reconstructive stage in group 3 involved Roux-en-Y isolation of the small intestine (Roux-en-Y reconstruction). Results . “Double” scintigraphic study revealed that the best result on the 30th and 90th postoperative days was observed in patients who underwent pancreaticoduodenal resection with pylorus preservation, reconstructive stage according to Child and formation of interintestinal anastomosis after Brown. Conclusion . “Double” scintigraphy is an effective procedure to determine the motility of the stomach, biliodigestive anastomosis and motility of the small intestine. As a result, the optimal reconstruction after pancreaticoduodenal resection was determined in patients with neoplasms of the pancreatic head or the periampullary region and chronic pancreatitis.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136237424","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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