Portal thrombosis is no longer considered a contraindication for transplantation because of the technical experience acquired in the field of liver transplantation and the development of various surgical techniques. All the same, the results obtained in portal thrombosis patients are at times suboptimal, and the surgical technique used (thromboendovenectomy or veno-venous bypass) is also controversial. Between May 1988 and December 2001, 455 liver transplants were performed, of which 32 (7%) presented portal vein thrombosis. Of these, eight belonged to the first 227 transplants (group I), and 24 to the other 228 (group II). Of the 32 cases with portal thrombosis, 20 (62%) were type Ib, seven (22%) type II/III and five (16%) type IV. Twenty-two were males (69%), with a mean age of 50 yr (range: 30-70 yr); the thrombosis in all cases developed over a cirrhotic liver: 15 cases of an ethanolic origin, 11 because of hepatitis C virus, two cases of autoimmune aetiology, one case of primary biliary cirrhosis, one case because of hepatitis B virus and two cases of a cryptogenic origin. Five cases had a history of surgical treatment for portal hypertension. The surgical method in all cases consisted of an eversion thromboendovenectomy (ETEV) under direct visual guidance, with occlusion of the portal flow using a Fogarty balloon. Once re-canalization was achieved, we performed local heparinization and end-to-end portal anastomosis. In no case was systemic post-operative heparinization performed. In the 32 cases in which thrombectomy was attempted it was achieved in 31 of them (96%), failing only in a case of type IV thrombosis, which was resolved by portal arterialization. Of the 31 successful cases, only one with type IV thrombosis re-thrombosed. The 5-yr survival rate of the patients in the series was 69%, with 10 patients dying, of whom only two from causes related to the thrombosis and the thrombosis treatment, both with type IV thrombosis. The ideal treatment for portal thrombosis during liver transplantation is controversial and depends on its extension and the experience of the surgeon. In our experience, ETEV resolves most thromboses (types I, II and III), but management of type IV, which occasionally can be treated with this technique, may require more complex procedures such as bypass, portal arterialization or cavoportal haemitransposition.

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Liver resection with HALS reproduces the low morbidity and mortality rates and effectiveness (3-year survival) of open surgery in SLTs when indicated selectively.

The introduction of biliary laparoscopic surgery led to an increase in the incidence of liver hilum injuries. These types of lesions are very serious, because they can lead to secondary biliary cirrhosis or fulminant hepatic failure and the need for liver transplantion (LT). We present three cases of liver hilum injuries, which were treated with LT; one case was due to severe and persistent cholangitis, and two cases were due to fulminant hepatic failure. The world literature is also reviewed, and published cases of iatrogenic lesions of the liver hilum caused by laparoscopic surgery and requiring LT are presented. These iatrogenic lesions of the hepatic hilum are complex and technically demanding, due to their high morbidity and mortality and even the need for LT. In conclusion, these lesions must be always managed in centers with experience in hepatobiliary surgery. (Liver Transpl 2004; 10:147-152.) T he incidence of iatrogenic lesions of the bile duct during open surgery has remained constant at 0.1-0.3% (approximately 1 case per 500 cholecystectomies). However, the introduction of laparoscopic surgery in the 1980s led to an extraordinary increase in this incidence, reaching 0.3-1% (1 per 200 cholecystectomies). 1-3 The lesions were considered to be much more serious due to a higher location in the hepatoduodenal ligament, often affecting the intrahepatic bile ducts and frequently leading to loss of sections of biliary tree. When the bile duct is the only hilar element involved, secondary biliary cirrhosis may be result as a consequence of prolonged cholestasis. 4,5 Lesions affecting the vessels of the hepatic hilum may lead to fulminant hepatic failure 6 -8 and the need for emergency liver transplantion (LT). The aim of this article is to present three cases of laparoscopic-induced iatrogenic lesions of the liver hilum, which resulted in irreversible liver damage requiring LT. The world literature is also reviewed, and published cases of laparoscopic-induced iatrogenic lesions of the liver hilum requiring LT are presented in Table 1. Patients and MethodsThis report involves three cases (Table 1) of laparascopicinduced hilar injuries, two males and one female with a mean age of 50 years (range, 39 -65 years). All of the lesions were caused during laparoscopic surgery for cholelithiasis, uncomplicated in two cases, and for acute cholecystitis in the other. All injuries occurred in other hospitals, and all of the patients underwent reoperation for reconstruction of the injured bile duct (BD) in one case and for hemostasis in the two other cases. Case 1A 48-year-old woman without a history of comorbidities was diagnosed with symptomatic cholelithiasis and underwent elective laparoscopic cholecystectomy in 1994. Bleeding occurred during the operation, and initial attempts to control the bleeding were done by the "blind" placement of multiple clips. As this appeared insufficient, conversion to open surgery was done, which achieved hemostasis with sutures in the liver hilum. During the postoperative period, the pat...

In patients with hepatic and pulmonary metastases from colorectal cancer selected according to strict inclusion criteria, surgical treatment performed in a specialized center is a safe option that offers prolonged survival.

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