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Reconstruction of Type V Hepatic Arterial in the Adult and Pediatric Liver Transplant Recipient
John Abraham Geha,
Matthew Benjamin Goss,
Joseph Daniel Geha,
Christine Ann O’Mahony,
Nhu Thao Nguyen Galvan,
Abbas Rana,
Ronald Timothy Cotton,
Michael Louis Kueht,
John Allen Goss
Issue:
Volume 8, Issue 1, February 2020
Pages:
1-4
Received:
24 November 2019
Accepted:
3 January 2020
Published:
13 January 2020
Abstract: The replaced common hepatic artery (RCHA) is an uncommon arterial anomaly that, when present, makes hepatic arterial reconstruction during liver transplantation technically challenging. At our institution, the reconstruction of the recipient RCHA consists of 2 techniques that include either an infrarenal donor iliac artery aortic conduit or a direct donor celiac trunk anastomosis to the proximal RCHA. Our experience demonstrates that the direct anastomosis to the RCHA provides a reliable source of arterial inflow, allows preservation of the recipient arterial anatomy, and minimizes the dissection required to create an infrarenal aortic conduit. Between September 1998 and April 2019, we performed 1782 liver transplants (1230 adults, >18 years; 552 pediatric, <18 years). There were 36 (2.92%) adult and 20 (3.07%) pediatric liver transplant recipients that possessed a RCHA. Allograft and patient survivals were 94.70% and 94.10%, in both the infrarenal conduit and direct Type-V anastomosis cohorts at 1 year, respectively. To date, hepatic artery thrombosis (HAT) has not occurred in the 2 cohorts of pediatric transplant recipients. In conclusion, the direct donor celiac trunk to RCHA anastomosis is a safe and effective way to perform arterial reconstruction with low hepatic artery thrombosis and biliary complication rates.
Abstract: The replaced common hepatic artery (RCHA) is an uncommon arterial anomaly that, when present, makes hepatic arterial reconstruction during liver transplantation technically challenging. At our institution, the reconstruction of the recipient RCHA consists of 2 techniques that include either an infrarenal donor iliac artery aortic conduit or a direc...
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Implications of Arterial Variations in Pancreatoduodenectomy for Cancer
Silvio Marcio Pegoraro Balzan,
Vinicius Grando Gava,
Érika Luiza Maschio,
Victoria Lucateli Bernardi,
Giana da Silva Lima,
Graziela de Gasperi,
Morgana Pizzolatti Marins,
Vanessa Batistella Kunzler,
Bruna Aparecida Fontana Costa
Issue:
Volume 8, Issue 1, February 2020
Pages:
5-8
Received:
10 November 2019
Accepted:
2 January 2020
Published:
17 January 2020
Abstract: Pancreatoduodenectomy for cancer is a complex surgical procedure with significant morbidity and mortality. Technical aspects of this procedure typically comprise dissection of celiac trunk, the common and the proper hepatic arteries. The presence of hepatic arterial anomalies is not uncommon and influences surgical technique. An aberrant right hepatic artery (replaced or accessory) or a common hepatic artery originating from the superior mesenteric artery are present in nearly 13% of cases and usually run in contact with the posterior aspect of the head of the pancreas. These anomalous arteries are at risk of iatrogenic injury and tumor involvement. Iatrogenic vascular lesions can lead to bleeding and/or ischemic complications, such as anastomotic stenosis, hepatic abscess and liver failure. Also, vascular tumor involvement might require arterial resection and reconstruction. The presence of arterial variations should not affect the radicalness of pancreatic resection as the involvement of aberrant arteries does not seem to affect postoperative outcomes or overall survival. These vascular variations should be, preferably, recognized pre-operatively in order to define possible surgical strategies. Preoperative contrast enhanced computed tomography provides accurate arterial anatomy evaluation. Lastly, aberrant hepatic arteries require proper dissection and/or occasionally resection and reconstruction during pancreatoduodenectomy to achieve a safe resection with proper radicalness. Knowledge of arterial variations is crucial for pancreatic cancer surgery.
Abstract: Pancreatoduodenectomy for cancer is a complex surgical procedure with significant morbidity and mortality. Technical aspects of this procedure typically comprise dissection of celiac trunk, the common and the proper hepatic arteries. The presence of hepatic arterial anomalies is not uncommon and influences surgical technique. An aberrant right hepa...
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The Association Between Postoperative Recovery and Psychosocial Factors in Cancer Patients
Saho Wada,
Ryoichi Sadahiro,
Yutaka Matsuoka,
Yosuke Uchitomi,
Ken Shimizu
Issue:
Volume 8, Issue 1, February 2020
Pages:
9-15
Received:
5 January 2020
Accepted:
20 January 2020
Published:
4 February 2020
Abstract: Surgery is one of the main treatments component against cancer. Although the basic principle of surgical treatment of cancer is curability, safety, and functionality, early recovery after surgery is also important. While some previous studies focus on physical recovery, there are few studies regarding the perioperative period of cancer patients and their impact on postoperative recovery. This study is aim to clarify psychosocial factors that affect postoperative recovery in cancer patients. The study design is a secondary data analysis of a prospective observational cohort study whose primary purpose was to investigate whether preoperative anxiety predicted onset of postoperative delirium in cancer patients at the National Cancer Center Hospital in Japan. The primary outcome of this study was the length of postoperative hospital stay, and the secondary outcome was postoperative complications. We conducted multivariable regression analysis to determine psychosocial predictors of primary and secondary outcomes. The final analysis included 109 patients. The mean length of postoperative hospital stay was 23.4 (SD = 12.4) days and the incidence rate of postoperative complications was 32.1%. In multivariable regression, preoperative anxiety was positively associated with the length of postoperative hospital stay, while sex (female) and alcohol dependence showed a negative association. Cognitive function was marginally associated with postoperative complications. In conclusion, Appropriate management of preoperative anxiety contributes to early discharge after surgery in cancer patients.
Abstract: Surgery is one of the main treatments component against cancer. Although the basic principle of surgical treatment of cancer is curability, safety, and functionality, early recovery after surgery is also important. While some previous studies focus on physical recovery, there are few studies regarding the perioperative period of cancer patients and...
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A Retrospective Risk Analysis of Factors Associated with Prolonged Hospitalization in Adult Patients Undergoing Non-surgical Treatment for Appendiceal Abscess
Masatsugu Hiraki,
Toshiya Tanaka,
Kohei Yamada,
Eiji Sadashima,
Tatsuya Manabe,
Kenji Kitahara,
Hirokazu Noshiro
Issue:
Volume 8, Issue 1, February 2020
Pages:
16-21
Received:
10 January 2020
Accepted:
21 January 2020
Published:
7 February 2020
Abstract: Background: The aim of the present study was to investigate risk factors and predictive factors for prolonged hospitalization in adults undergoing non-surgical treatment for appendiceal abscess. Patients and Methods: A retrospective study was conducted of consecutive patients who underwent treatment following a diagnosis of appendicitis in a single institution. Between January 2008 and May 2019, 756 adult patients who were diagnosed with acute appendicitis, 101 of these patients (13.4%) had an appendiceal abscess and were treated as inpatients. The treatments of these patients were as follows: non-surgical treatment alone (n=45), emergency operation (n=50) and conversion to emergency operation due to failure of the initial conservative therapy (n=6). The present study analyzed the 45 patients managed with non-surgical treatment alone. The patients were divided, based on the median length of the hospital stay (nine day), into the shorter hospital stay and longer hospital stay groups. The risk factors and predictive factors for prolonged hospitalization were examined in the two groups. Results: Twenty-four patients were classified into the shorter hospital stay group and 21 were classified into the longer hospital stay group. A univariate analysis demonstrated that the body temperature on post-admission days 2 (P=0.012) and 3 (P=0.008), were significantly associated with the length of hospital stay. A multivariate logistic regression analysis using that the body temperature on post-admission day 3 tended to be associated with prolonged hospitalization (odds ratio=8.574, 95% confidence interval=0.973-75.525; P=0.053). The cut-off value of the body temperature on day 3, determined by an ROC curve analysis, was 37.05°C. This cut-off value showed 66.7% accuracy, 57.1% sensitivity and 75.0% specificity. Conclusion: The body temperature on post-admission day 3 might be a potential risk factor and predictive marker for prolonged hospitalization in patients who receive non-surgical treatment for appendiceal abscess.
Abstract: Background: The aim of the present study was to investigate risk factors and predictive factors for prolonged hospitalization in adults undergoing non-surgical treatment for appendiceal abscess. Patients and Methods: A retrospective study was conducted of consecutive patients who underwent treatment following a diagnosis of appendicitis in a single...
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013Novel Method of Substitution for Combine Through-and-through Angle of the Mouth, Fragments of Upper and Lower Lips Defect
Igor Zaderenko,
Ali Mudunov,
Sergey Ivanov,
Sevil Alieva,
Vasiliy Tsiklauri,
Alexander Kazimov,
David Safarov,
Alexandra Eremina,
Alena Hromushina,
Bulat Bektimirov,
Alexander Dymnikov
Issue:
Volume 8, Issue 1, February 2020
Pages:
22-27
Received:
5 December 2019
Accepted:
29 January 2020
Published:
10 February 2020
Abstract: Through-and-through defect of soft tissues of the cheek, mouth angles, upper and lower lip originate from surgical intervention of tumors of the oral cavity involving external skin, soft tissue and oral lining. The article describes an original method of one-stage reconstruction in N. N. Blokhin National Medical and Research Center of Oncology. Russian Federation’s patent № 2489096 was granted for this method. We propose to use 3 different flaps from different anatomic areas, which have varying histological structures and independent blood supply. The first flap - muscle, is formed from the biggest part of the muscles masseter from the affected side and serves to restore the functions of the lips and cheek due to the fact that after the formation of the flap two its parts fixed to the remnants of the muscles of the upper and lower lips and part of the buccal muscle. The flap is perfusion by a. maxillaris and a. facialis. The second flap - musculocutaneous, formed from the skin of areas adjacent to the defect, nasolabial or submandibular. The flap serves to replace a skin defect, defect of the cheek, upper and lower lips. The flap is perfusion by a. facialis. The third flap - fascial, formed from the temporal fascia on the affected side. The temporal fascial flap is used to replace the defect of the mucous membrane of the cheek, upper and lower lips, in addition, the red border of the lips and the corner of the mouth. The flap is perfusion by aa. temporalis profunda et superficialis. All three flaps perfectly carry out hermetic sealing of the oral cavity, independent perfusion of each flap, even in the case of necrosis of one of the flaps, allows preservation of hermeticism. The use of three flaps with different histological structure allows to achieve a good functional and aesthetic result. Flaps perform various functions, ensuring the functional and anatomical usefulness of the resected tissues. By improving the blood suppling of flaps, we reduce time for patient’s rehabilitation and postoperative damage.
Abstract: Through-and-through defect of soft tissues of the cheek, mouth angles, upper and lower lip originate from surgical intervention of tumors of the oral cavity involving external skin, soft tissue and oral lining. The article describes an original method of one-stage reconstruction in N. N. Blokhin National Medical and Research Center of Oncology. Rus...
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Surgical Reatment of Acromioclavicular Dislocation-reconstruction of Coracoclavicular Ligament
Wuji Li,
Wenrui Wu,
Xiaofei Zheng,
Simin Luo
Issue:
Volume 8, Issue 1, February 2020
Pages:
28-33
Received:
26 December 2019
Accepted:
15 January 2020
Published:
26 February 2020
Abstract: Background: Dislocation of acromioclavicular joint is a relatively common injury, accounting for about 9% to 10% of all shoulder injuries. There are many surgical methods to treat dislocation of acromioclavicular joint, including fixation through acromioclavicular joint, intercoracoid fixation and ligament reconstruction. However, at present, more and more attention has been paid to biological reconstruction technology, and related technologies have also been greatly developed. Methods: The semitendinosus tendon from the body is used as the material for the reconstruction of the ligament. The reconstruction holes were made at the original attachment of the clavicular conical ligament and the trapezium ligament, and 10 absorbable lines were taken to pass through the lower part of the coracoid process through the two reconstruction holes respectively. The semitendinosus tendon was pruned, and the two ends were inserted through the reconstruction holes respectively to reach the lower part of the coracoid process. While pressing down on the clavicle, 10 absorbable lines were knotted on the surface of the clavicle, and the semitendinosus tendon was knotted below the coracoid process. Finally, two u-shaped loops were formed to complete the reconstruction of the coracoid ligaments. Results: The intraoperative and post-operative imaging examination indicated that acromioclavicular joint dislocation was well treated. Conclusions: This kind of surgery has many advantages over traditional plate fixation, such as reducing postoperative complications, shortening the length of hospital stay and so on.
Abstract: Background: Dislocation of acromioclavicular joint is a relatively common injury, accounting for about 9% to 10% of all shoulder injuries. There are many surgical methods to treat dislocation of acromioclavicular joint, including fixation through acromioclavicular joint, intercoracoid fixation and ligament reconstruction. However, at present, more ...
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Clinical Effect of Single-Site Laparoscopy in the Treatment of Meckel's Diverticulum in Children
Chen Jiarong,
Huang Jingjing,
Shi Qunfeng,
Zeng Danping
Issue:
Volume 8, Issue 1, February 2020
Pages:
34-37
Received:
16 February 2020
Accepted:
24 February 2020
Published:
2 March 2020
Abstract: Purpose: To observe the clinical effect of laparoscopic surgery on Meckel's diverticulum in children with (MD). Method: The clinical data of 20 children were analyzed retrospectively. All children were treated with laparoscopic surgery at single part of the umbilical cord, and the operation, clinical effects and postoperative complications were observed. Result: All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusion: Umbilical laparoscopy is effective in the treatment of pediatric MD with less trauma, simple operation, short operation time and quick recovery after operation. Background Meckel's diverticulum is the most common congenital developmental malformation of the gastrointestinal tract, which is a mesenteric malformation caused by embryonic yolk tube degeneration. The incidence in the population is 2.0%, most patients have no clinical symptoms, occasionally found in autopsy, laparotomy, clinical diagnosis is more difficult. The clinical manifestations of its complications are easy to be confused with other diseases such as intussusception, colonic polyps, necrotizing enteritis and acute appendicitis perforation. Date sources Based on the progress in the treatment of Meckel's diverticulum in children at home and abroad, the clinical data of 20 children with Meckel's diverticulum treated in our hospital were analyzed retrospectively to observe the clinical effect of laparoscopy-assisted operation in the treatment of Meckel's diverticulum in children. Results All the 20 children completed the operation successfully, and the operation time was 50. 5%. 2 ±5. 4) there were no complications such as abdominal pain, abdominal distension, vomiting, bleeding, intestinal adhesion obstruction, intestinal stricture and intestinal anastomotic fistula during and after min,. During the follow-up of 1 ~ 26 months, all the children ate and defecated normally and there was no recurrence. Conclusions Surgical resection is the first choice for symptomatic Meckel diverticulum in children, and laparoscopic surgery is the first choice. The operative method of laparoscopic treatment of Meckel diverticulum in children with single part of umbilical cord has the advantages of less trauma, simple operation, short operation time and quick recovery after operation, and the operative effect is good.
Abstract: Purpose: To observe the clinical effect of laparoscopic surgery on Meckel's diverticulum in children with (MD). Method: The clinical data of 20 children were analyzed retrospectively. All children were treated with laparoscopic surgery at single part of the umbilical cord, and the operation, clinical effects and postoperative complications were obs...
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Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias
Ajogwu Ugwu,
Khurram Shahzad Khan,
Kit Chow
Issue:
Volume 8, Issue 1, February 2020
Pages:
38-42
Received:
29 November 2019
Accepted:
23 December 2019
Published:
3 March 2020
Abstract: Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.
Abstract: Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which include...
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