Pub Date : 2022-12-15DOI: 10.16931/1995-5464.2022-4-41-46
D. Podluzhny, Y. Patyutko, A. N. Polyakov, A. G. Kotel'nikov, E. Moroz, B. I. Sakibov, N. Kudashkin
Aim. To improve outcomes of treatment for neoplasms in segments VII-VIII of the liver adjacent to the main stem of the right hepatic vein and/or to its forming large branches.Materials and methods. In the period of 2016–2022, the resection of segments VII and/or VIII of the liver and the right hepatic vein, as well as its forming branches without reconstruction was performed in 24 patients. Surgical indications were liver metastases of colorectal cancer in 15 cases, hepatocellular cancer (cholangiocarcinoma) in six cases, angiomyolipoma in one case, uterine cancer metastases in one case and primary retroperitoneal tumor metastases in one case. Minor liver resections were additionally performed in 11 cases. Results. There were no intraoperative signs of impaired venous drainage. After surgery bile in the drains was detected in three patients, and a biliary fistula was formed in one case. No other complications were identified. No fatalities were registered after surgery. The late postoperative period revealed no specific complications related to a disturbance of venous drainage through the right hepatic vein.Conclusion. Existing and emerging collaterals can provide adequate venous drainage to the middle hepatic vein, short hepatic veins after resection of liver segments VII and VIII with resection of the right hepatic vein stem and its forming branches without reconstruction, even if the lower right hepatic vein is missing, and without complete obstruction of the right hepatic vein before surgery.
{"title":"Resecting liver segments VII–VIII without reconstructing the right hepatic vein","authors":"D. Podluzhny, Y. Patyutko, A. N. Polyakov, A. G. Kotel'nikov, E. Moroz, B. I. Sakibov, N. Kudashkin","doi":"10.16931/1995-5464.2022-4-41-46","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-41-46","url":null,"abstract":"Aim. To improve outcomes of treatment for neoplasms in segments VII-VIII of the liver adjacent to the main stem of the right hepatic vein and/or to its forming large branches.Materials and methods. In the period of 2016–2022, the resection of segments VII and/or VIII of the liver and the right hepatic vein, as well as its forming branches without reconstruction was performed in 24 patients. Surgical indications were liver metastases of colorectal cancer in 15 cases, hepatocellular cancer (cholangiocarcinoma) in six cases, angiomyolipoma in one case, uterine cancer metastases in one case and primary retroperitoneal tumor metastases in one case. Minor liver resections were additionally performed in 11 cases. Results. There were no intraoperative signs of impaired venous drainage. After surgery bile in the drains was detected in three patients, and a biliary fistula was formed in one case. No other complications were identified. No fatalities were registered after surgery. The late postoperative period revealed no specific complications related to a disturbance of venous drainage through the right hepatic vein.Conclusion. Existing and emerging collaterals can provide adequate venous drainage to the middle hepatic vein, short hepatic veins after resection of liver segments VII and VIII with resection of the right hepatic vein stem and its forming branches without reconstruction, even if the lower right hepatic vein is missing, and without complete obstruction of the right hepatic vein before surgery.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44204860","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-117-124
R. Kursenko, A. Trushin, D. A. Zaitsev, I. Vervekin, A. Svechkova, M. Belyaev, A. А. Zaharenko
The incidence of infectious complications after pancreaticoduodenal resection remains significant. High frequency of bacteriocholia in this category of patients is a result of preoperative biliary drainage. The role of bacteriocholia in the development of surgical site infection and the methods of exposure to it are yet to be studied. The authors presented the analysis of Russian and foreign literature and considered the role of bacteriocholia in the development of surgical site infection after pancreaticoduodenal resection. Bacteriocholia appears to be one of the most significant factors in the surgical site infection after this kind of resection. Bacterial cultures in the intraoperative bile sample and the surgical microbiome are represented by pathogens resistant to standard drugs used for perioperative antibiotic prophylaxis. In order to decrease the incidence of surgical site infections after the pancreaticoduodenal resection it is essential to continue searching for the methods of exposure to bacteriocholia including revision of the approaches to perioperative administration of antibacterial agents.
{"title":"Role of bacteriocholia in development of infectious complications of pancreaticoduodenal resection","authors":"R. Kursenko, A. Trushin, D. A. Zaitsev, I. Vervekin, A. Svechkova, M. Belyaev, A. А. Zaharenko","doi":"10.16931/1995-5464.2022-4-117-124","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-117-124","url":null,"abstract":"The incidence of infectious complications after pancreaticoduodenal resection remains significant. High frequency of bacteriocholia in this category of patients is a result of preoperative biliary drainage. The role of bacteriocholia in the development of surgical site infection and the methods of exposure to it are yet to be studied. The authors presented the analysis of Russian and foreign literature and considered the role of bacteriocholia in the development of surgical site infection after pancreaticoduodenal resection. Bacteriocholia appears to be one of the most significant factors in the surgical site infection after this kind of resection. Bacterial cultures in the intraoperative bile sample and the surgical microbiome are represented by pathogens resistant to standard drugs used for perioperative antibiotic prophylaxis. In order to decrease the incidence of surgical site infections after the pancreaticoduodenal resection it is essential to continue searching for the methods of exposure to bacteriocholia including revision of the approaches to perioperative administration of antibacterial agents.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42668363","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-47-56
D. Akhaladze, G. Rabaev, N. Merkulov, I. V. Tverdov, N. Uskova, S. Talypov, A. A. Krivonosov, N. S. Grachev
Aim. To analyze the results of liver resection for neoplasms of hepatico-caval confluence without hepatic vein reconstruction in children.Materials and methods. From June 2017 to April 2022, surgical treatment was performed in 5 patients with tumors in hepatico-caval confluence requiring resection of the right hepatic vein and/or median hepatic vein.Results. Two children underwent VII, VIII bisegmentectomy, one of them – laparoscopically. One child underwent laparoscopically assisted IVa, VIII subsegmentectomy. Two children underwent I, IVa, VIII trisegmentectomy with atypical SII, III resection, as well as IVa, VIII, VII trisegmentectomy with I segmentectomy. The median duration of5surgery was 445 min. (315–785), the median blood loss was 400 ml (150–3000). In the postoperative period, complications developed in 2 patients (IIIa and IIIb according to Clavien-Dindo classification), no disturbance of venous outflow from the lower segments of the liver was detected. Vascular margin of R1 resection was obtained in case 1.Conclusion. In the majority of cases of hepatico-caval confluence tumors in children, liver resection, when carefully planned, does not require prosthetics of the right hepatic vein and/or middle hepatic vein and is not accompanied by venous outflow disturbance from the lower liver segments by means of the collaterals to the preserved hepatic veins.
{"title":"Complex resections for focal neoplasms of hepatico-caval confluence in children","authors":"D. Akhaladze, G. Rabaev, N. Merkulov, I. V. Tverdov, N. Uskova, S. Talypov, A. A. Krivonosov, N. S. Grachev","doi":"10.16931/1995-5464.2022-4-47-56","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-47-56","url":null,"abstract":"Aim. To analyze the results of liver resection for neoplasms of hepatico-caval confluence without hepatic vein reconstruction in children.Materials and methods. From June 2017 to April 2022, surgical treatment was performed in 5 patients with tumors in hepatico-caval confluence requiring resection of the right hepatic vein and/or median hepatic vein.Results. Two children underwent VII, VIII bisegmentectomy, one of them – laparoscopically. One child underwent laparoscopically assisted IVa, VIII subsegmentectomy. Two children underwent I, IVa, VIII trisegmentectomy with atypical SII, III resection, as well as IVa, VIII, VII trisegmentectomy with I segmentectomy. The median duration of5surgery was 445 min. (315–785), the median blood loss was 400 ml (150–3000). In the postoperative period, complications developed in 2 patients (IIIa and IIIb according to Clavien-Dindo classification), no disturbance of venous outflow from the lower segments of the liver was detected. Vascular margin of R1 resection was obtained in case 1.Conclusion. In the majority of cases of hepatico-caval confluence tumors in children, liver resection, when carefully planned, does not require prosthetics of the right hepatic vein and/or middle hepatic vein and is not accompanied by venous outflow disturbance from the lower liver segments by means of the collaterals to the preserved hepatic veins.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41434882","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-23-30
I. Rutkin, V. N. Zhuikov, V. E. Moiseenko, D. Granov
Aim. To evaluate outcomes of laparoscopic liver resections in patients with hepatocellular carcinoma (HCC).Materials and methods. 40 endovideosurgical liver resections were performed in patients with HCC in the period of 2011–2021. Concomitant cirrhosis was detected in 36 cases (90%).Results. The average duration of surgery was 158.1 ± 78.6 min. The duration of anatomical lobar resections appeared to be the longest – 230 min. The average volume of intraoperative blood loss was 259.5 ± 260.5 ml, which almost excluded blood transfusions. The duration of hospitalization comprised 11.2 ± 2.3 days. One-year survival was achieved in 95% of cases, two-year – in 81%, three-year – in 64%.Conclusion. Laparoscopic liver resections in hepatocellular carcinoma prove to be safe and provide satisfactory surgical and oncological outcomes.
{"title":"Minimally invasive surgery for hepatocellular carcinoma","authors":"I. Rutkin, V. N. Zhuikov, V. E. Moiseenko, D. Granov","doi":"10.16931/1995-5464.2022-4-23-30","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-23-30","url":null,"abstract":"Aim. To evaluate outcomes of laparoscopic liver resections in patients with hepatocellular carcinoma (HCC).Materials and methods. 40 endovideosurgical liver resections were performed in patients with HCC in the period of 2011–2021. Concomitant cirrhosis was detected in 36 cases (90%).Results. The average duration of surgery was 158.1 ± 78.6 min. The duration of anatomical lobar resections appeared to be the longest – 230 min. The average volume of intraoperative blood loss was 259.5 ± 260.5 ml, which almost excluded blood transfusions. The duration of hospitalization comprised 11.2 ± 2.3 days. One-year survival was achieved in 95% of cases, two-year – in 81%, three-year – in 64%.Conclusion. Laparoscopic liver resections in hepatocellular carcinoma prove to be safe and provide satisfactory surgical and oncological outcomes.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49410306","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-125-134
Kh. A. Ayvazyan, B. Gurmikov, R. O. Anvari, Y. Stepanova, D. V. Kalinin, A. Glotov, V. S. Shirokov, L. Marinova, M. Kadirova, E. Malyshenko, A. V. Zhao
Cholangioblastic variant of intrahepatic cholangiocarcinoma is a rare, extremely malignant liver tumor. Currently, only six clinical cases have been described worldwide. Following the bibliographic research, the authors of the paper introduced main features of the tumor, methods of its diagnosis and treatment. A clinical observation of a patient with cholangioblastic variant of intrahepatic cholangiocarcinoma is presented. The course of the disease was complicated by tumor thrombosis of the left hepatic and inferior vena cava with thrombus flotation in the right atrium. The paper describes the stages of the disease diagnosis and surgical treatment of the patient, providing insight into the patient surveillance in such cases. Given the low incidence of such neoplasms, each clinical case reported in the scientific literature is of great value and practical interest.
{"title":"Cholangioblastic liver carcinoma","authors":"Kh. A. Ayvazyan, B. Gurmikov, R. O. Anvari, Y. Stepanova, D. V. Kalinin, A. Glotov, V. S. Shirokov, L. Marinova, M. Kadirova, E. Malyshenko, A. V. Zhao","doi":"10.16931/1995-5464.2022-4-125-134","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-125-134","url":null,"abstract":"Cholangioblastic variant of intrahepatic cholangiocarcinoma is a rare, extremely malignant liver tumor. Currently, only six clinical cases have been described worldwide. Following the bibliographic research, the authors of the paper introduced main features of the tumor, methods of its diagnosis and treatment. A clinical observation of a patient with cholangioblastic variant of intrahepatic cholangiocarcinoma is presented. The course of the disease was complicated by tumor thrombosis of the left hepatic and inferior vena cava with thrombus flotation in the right atrium. The paper describes the stages of the disease diagnosis and surgical treatment of the patient, providing insight into the patient surveillance in such cases. Given the low incidence of such neoplasms, each clinical case reported in the scientific literature is of great value and practical interest.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46487525","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-91-99
M. Prudkov, A. D. Kovalevskii
Aim. To explore the potential of transfistula fibrocholangioscopy for the definite diagnosis and correction of drainage disturbances in the major duodenal papilla and the terminal portion of the common bile duct.Materials and methods. In the period of 2017–2019, we examined 230 patients with functioning external biliary drains, who underwent surgery in the hospitals of the region. Residual concrements were identified and removed from the bile ducts of 158 patients through external biliary fistulas. The research methodology involved monitoring the external bile flow rate, fistulocholangiography and transfistula fibrocholangioscopy to examine bile outflow through the common bile duct and major papilla before and after stones removal, elimination of cholangitis and papillitis.Results. The examination of 37 patients revealed no obstruction to bile drainage. After eliminating the cause of papillitis (cholangiolithiasis, drainage) and inflammatory changes the bile outflow through the major papilla was restored in 112 patients. The bile outflow disturbance persisted in 81 patients after removal of abnormalities in the terminal portion of the common bile duct and major papilla. 70 of them underwent the graduated 'rendezvous' papillotomy, and seven – antegrade balloon dilatation. Four patients underwent a rendezvous papillotomy with antegrade balloon dilatation. The failure rate was 1.2%, complications – 9.9%, including III–IV grade complications (2.5%) according to the Clavien–Dindo classification. One patient died (1.2%).Conclusion. Antegrade transfistula fibrocholangioscopy methods of endobiliary examination and bile duct sanitation comprise a valuable contribution to modern biliary surgery. They are mostly appropriate to be applied in centers which a focus on residual diseases of the bile ducts.
{"title":"Transfistula fibrocholangioscopy: diagnosis and correction for major duodenal papilla drainage disturbances","authors":"M. Prudkov, A. D. Kovalevskii","doi":"10.16931/1995-5464.2022-4-91-99","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-91-99","url":null,"abstract":"Aim. To explore the potential of transfistula fibrocholangioscopy for the definite diagnosis and correction of drainage disturbances in the major duodenal papilla and the terminal portion of the common bile duct.Materials and methods. In the period of 2017–2019, we examined 230 patients with functioning external biliary drains, who underwent surgery in the hospitals of the region. Residual concrements were identified and removed from the bile ducts of 158 patients through external biliary fistulas. The research methodology involved monitoring the external bile flow rate, fistulocholangiography and transfistula fibrocholangioscopy to examine bile outflow through the common bile duct and major papilla before and after stones removal, elimination of cholangitis and papillitis.Results. The examination of 37 patients revealed no obstruction to bile drainage. After eliminating the cause of papillitis (cholangiolithiasis, drainage) and inflammatory changes the bile outflow through the major papilla was restored in 112 patients. The bile outflow disturbance persisted in 81 patients after removal of abnormalities in the terminal portion of the common bile duct and major papilla. 70 of them underwent the graduated 'rendezvous' papillotomy, and seven – antegrade balloon dilatation. Four patients underwent a rendezvous papillotomy with antegrade balloon dilatation. The failure rate was 1.2%, complications – 9.9%, including III–IV grade complications (2.5%) according to the Clavien–Dindo classification. One patient died (1.2%).Conclusion. Antegrade transfistula fibrocholangioscopy methods of endobiliary examination and bile duct sanitation comprise a valuable contribution to modern biliary surgery. They are mostly appropriate to be applied in centers which a focus on residual diseases of the bile ducts.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46654256","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-84-90
S. Ismailov, F. Nazyrov, A. V. Devyatov, A. Babadjanov, R. R. Baybekov, A. I. Tuksanov
Aim. To compare the incidence and timing of recurrent bleeding from esophageal and gastric varices against the background of extrahepatic portal hypertension after various interventions.Materials and methods. The research methodology involved analyzing the treatment results of 131 patients with extrahepatic portal hypertension who underwent various surgical interventions from 2006 to 2020. Total dissociation of the gastroesophageal collector was carried out in 57 patients (43.5%), portosystemic shunting – in 51 (38.9%), endoscopic interventions – in 23 (17.6%).Results. When comparing the recurrent bleeding rate, it was found out that the most effective intervention is portosystemic shunting. After endoscopic interventions the bleeding rate is 65.2%, and rebleeding occurs in 13.5 ± 2.9 months. After total dissociation of the gastroesophageal collector, a recurrence-free course was observed in 35.1% of cases (p = 0.014), with timing of 25.9 ± 4.4 months (p < 0.05). In terms of timing, this did not differ from the recurrence after portosystemic shunt surgery (41.4 ± 8.2 months), but was significantly less in the bleeding rate after decompressive surgery (17.6%; p < 0.001). Conclusion. Portosystemic shunt surgery proves to be the most effective intervention in extrahepatic portal hypertension, with a five-year remission in 75% of cases. After dissociative surgeries, 35.1% of patients experienced recurrent bleeding, with average timing of 19.6 months.
{"title":"Analysis of recurrent bleeding rate after various surgical interventions in extrahepatic portal hypertension","authors":"S. Ismailov, F. Nazyrov, A. V. Devyatov, A. Babadjanov, R. R. Baybekov, A. I. Tuksanov","doi":"10.16931/1995-5464.2022-4-84-90","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-84-90","url":null,"abstract":"Aim. To compare the incidence and timing of recurrent bleeding from esophageal and gastric varices against the background of extrahepatic portal hypertension after various interventions.Materials and methods. The research methodology involved analyzing the treatment results of 131 patients with extrahepatic portal hypertension who underwent various surgical interventions from 2006 to 2020. Total dissociation of the gastroesophageal collector was carried out in 57 patients (43.5%), portosystemic shunting – in 51 (38.9%), endoscopic interventions – in 23 (17.6%).Results. When comparing the recurrent bleeding rate, it was found out that the most effective intervention is portosystemic shunting. After endoscopic interventions the bleeding rate is 65.2%, and rebleeding occurs in 13.5 ± 2.9 months. After total dissociation of the gastroesophageal collector, a recurrence-free course was observed in 35.1% of cases (p = 0.014), with timing of 25.9 ± 4.4 months (p < 0.05). In terms of timing, this did not differ from the recurrence after portosystemic shunt surgery (41.4 ± 8.2 months), but was significantly less in the bleeding rate after decompressive surgery (17.6%; p < 0.001). Conclusion. Portosystemic shunt surgery proves to be the most effective intervention in extrahepatic portal hypertension, with a five-year remission in 75% of cases. After dissociative surgeries, 35.1% of patients experienced recurrent bleeding, with average timing of 19.6 months.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47050642","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-15-22
G. Akhaladze, O. Ivanova
Liver surgery constantly undergoes significant changes and is greatly influenced by scientific and technological developments. At present, liver resection gives hope for the patient's recovery. New tendencies in liver surgery include parenchyma-sparing surgery, minimization of resection margin, skeletonization of blood vessels. The principle of resection along the hepatic veins with specifically detailed landmarks is currently being introduced. This allows surgeons to expand their capabilities by covering new cohorts of patients with multiple tumors, previously considered unresectable. Immediate results are improving without a negative impact on long-term surgical outcomes.
{"title":"Current trends in liver surgery (literature review)","authors":"G. Akhaladze, O. Ivanova","doi":"10.16931/1995-5464.2022-4-15-22","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-15-22","url":null,"abstract":"Liver surgery constantly undergoes significant changes and is greatly influenced by scientific and technological developments. At present, liver resection gives hope for the patient's recovery. New tendencies in liver surgery include parenchyma-sparing surgery, minimization of resection margin, skeletonization of blood vessels. The principle of resection along the hepatic veins with specifically detailed landmarks is currently being introduced. This allows surgeons to expand their capabilities by covering new cohorts of patients with multiple tumors, previously considered unresectable. Immediate results are improving without a negative impact on long-term surgical outcomes.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":"68 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41257846","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-100-109
A. Mamoshin, Y. Ivanov, A. Borsukov, Yu. M. Morozov, V. F. Muradyan, A. Abolmasov, D. Sumin, D. N. Panchenkov
Aim. To evaluate the potential and effectiveness of antegrade X-ray surgical interventions as treatment choice to eliminate the cholecysto- and choledocholithiasis in the complicated cholelithiasis.Materials and methods. We carried out an analysis of the results of staged X-ray surgical treatment of 29 patients with cholecysto- and/or choledocholithiasis having relative or absolute counterindications to the implementation of laparoscopy, open surgery or endoscopy. Thirteen patients (44.8%) were revealed to have diverticulum of the major duodenal papilla; seven (24.1%) – coronary heart disease with chronic heart failure. Five patients (17.2%) had previously undergone gastrectomy. Severe diseases of the respiratory organs were detected in four cases (13.7%). The primary intervention included percutaneous microcholecystostomy and percutaneous transhepatic cholangiostomy. The drainage channel formation was followed by cholecysto- and choledocholangioscopy, mechanical and pneumatic lithotripsy, lithoextraction.Results. A total of 34 percutaneous minimally invasive interventions were performed. Percutaneous transhepatic biliary drainage was performed in 23 cases (67.6%), percutaneous microcholecystostomy – in seven (20.5%), and percutaneous drainage of peri- and intrahepatic abscesses was additionally carried out in four cases (11.9%). At the second stage, seven patients (24.4%) underwent cholecystoscopy and 20 (68.8%) – choledocholangioscopy. Both interventions were used in two cases (6.8%). In all cases, the work resulted in eliminating the complications of cholelithiasis, cholecystosis and/or choledocholithiasis with restorating the bile passage by means of percutaneous minimally invasive technologies. No fatal outcomes or complications were recorded.Conclusion. Antegrade X-ray surgical technologies are effective minimally invasive choice treatment to eliminate the cholecysto- and choledocholithiasis with counterindications to other surgical treatments in the complicated cholelithiasis.
{"title":"Antegrade minimally invasive technologies in treatment of complicated cholelithiasis","authors":"A. Mamoshin, Y. Ivanov, A. Borsukov, Yu. M. Morozov, V. F. Muradyan, A. Abolmasov, D. Sumin, D. N. Panchenkov","doi":"10.16931/1995-5464.2022-4-100-109","DOIUrl":"https://doi.org/10.16931/1995-5464.2022-4-100-109","url":null,"abstract":"Aim. To evaluate the potential and effectiveness of antegrade X-ray surgical interventions as treatment choice to eliminate the cholecysto- and choledocholithiasis in the complicated cholelithiasis.Materials and methods. We carried out an analysis of the results of staged X-ray surgical treatment of 29 patients with cholecysto- and/or choledocholithiasis having relative or absolute counterindications to the implementation of laparoscopy, open surgery or endoscopy. Thirteen patients (44.8%) were revealed to have diverticulum of the major duodenal papilla; seven (24.1%) – coronary heart disease with chronic heart failure. Five patients (17.2%) had previously undergone gastrectomy. Severe diseases of the respiratory organs were detected in four cases (13.7%). The primary intervention included percutaneous microcholecystostomy and percutaneous transhepatic cholangiostomy. The drainage channel formation was followed by cholecysto- and choledocholangioscopy, mechanical and pneumatic lithotripsy, lithoextraction.Results. A total of 34 percutaneous minimally invasive interventions were performed. Percutaneous transhepatic biliary drainage was performed in 23 cases (67.6%), percutaneous microcholecystostomy – in seven (20.5%), and percutaneous drainage of peri- and intrahepatic abscesses was additionally carried out in four cases (11.9%). At the second stage, seven patients (24.4%) underwent cholecystoscopy and 20 (68.8%) – choledocholangioscopy. Both interventions were used in two cases (6.8%). In all cases, the work resulted in eliminating the complications of cholelithiasis, cholecystosis and/or choledocholithiasis with restorating the bile passage by means of percutaneous minimally invasive technologies. No fatal outcomes or complications were recorded.Conclusion. Antegrade X-ray surgical technologies are effective minimally invasive choice treatment to eliminate the cholecysto- and choledocholithiasis with counterindications to other surgical treatments in the complicated cholelithiasis.","PeriodicalId":36549,"journal":{"name":"Annals of HPB Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43444182","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 : 2022-12-15DOI: 10.16931/1995-5464.2022-4-31-40
M. Efanov, R. Alikhanov, I. Kazakov, A. Koroleva, A. Vankovich, O. Melekhina, Y. Kulezneva, P. Tarakanov, M. N. Kaminsky, N. Britskaia, D. V. Fisenko, V. Tsvirkun, I. Khatkov
Aim. To compare the immediate and long-term results of robot-assisted and open resection of the liver and bile ducts for portal cholangiocarcinoma.Materials and methods. The retrospective study was based upon the results of open and robot-assisted resections in 2013–2021. Patients without signs of the tumor invasion into the great vessels requiring resection and reconstruction were selected for the robot-assisted resection of the liver and bile ducts. Propensity score matching was carried out within the immediate environment in the ratio 1:2 for five covariates.Results. The results of 147 open resections of the liver and bile ducts and 17 robot-assisted resections were compared. After propensity score matching, the authors compared 33 open and 17 robot-assisted resections. Before and after propensity score matching, statistically significant differences were obtained only in the longer duration of robotassisted resections. Right hepatectomy and caudal resection were performed more frequently in the group of patients with robot-assisted interventions, but without significant differences. The authors noted a tendency to a higher frequency of R0 and a lower 90-day mortality rate after robot-assisted interventions, with no differences in the rate and nature of complications, as well as in duration of hospitalization. Survival did not differ before and after propensity score matching. After open and robot-assisted interventions the overall five-year survival rates before propensity score matching were 32% and 67%, after propensity score matching the overall four-year survival rates accounted for 62% and 63%.Conclusion. Analysis of the first experience shows a tendency to improve some immediate outcomes without worsening survival. Robot-assisted resection of the liver and bile ducts can be applied, without limitation of oncologic principles, in selected patients with portal cholangiocarcinoma if the resection is performed in specialized hepatological centers, where specialists have experience in minimally invasive surgery.
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