LSG provides good short- and mid-term results with a low morbid-mortality rate. Better results are obtained in younger patients with lowest BMI. Staple-line reinforcement and a thinner bougie are recommended to improve outcome.

Hypothesis: Analysis of the type and characteristics of complications after laparoscopic splenectomy may permit the identification of clinical factors with predictive value for the development of complications. Design: Univariate and multivariate analysis of factors related to complications in a prospective series of laparoscopic splenectomies. Setting: A large tertiary referral university-teaching general hospital. Patients: One hundred twenty-two nonselected consecutive patients, in whom laparoscopic splenectomy was attempted between February 1993 and July 1999. Intervention: Laparoscopic splenectomy. Main Outcome Measures: Immediate complications classified according to the Clavien score. Univariate and multivariate analyses were performed of complications related to age, sex, body mass index, and malignant nature of the hematologic disease; preoperative hematocrit and platelet count; operative time; operative position; need of accessory incision; transfusion status; learning curve; and existence of comorbid diseases. Clinical Outcome Value* Operative time, min 153 ± 59 (60-240) Transfusion, % 18 Morbidity, % 18 Hospital stay, d 4 ± 2 (2-14) Spleen weight, g 493 ± 588 (60-3200) Accessory spleen, % 12 Accessory incision, % 36 *Data are given as mean ± SD (range) unless otherwise indicated. No conversions were related to intraoperative complications. Twenty

LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases and a long-term hematological response comparable to the standard results that have been observed in open series.

Accurate preoperative depiction of biliary anatomy is not always adequately accomplished by imaging techniques in living donor liver transplantation (LDLT).A dult living-donor liver transplantation (LDLT) has been developed as an alternative to cadaveric liver transplantation, due to the shortage of organs. Assessment of the biliary anatomy and identification of normal variants are challenging points in the donor selection process and surgical planning. Biliary anatomy is variable and a conventional branching pattern of the common bile duct into right and left ducts is only present in 57% to 60% of the normal population. 1 -4 These variants frequently involve anomalous drainage of the right anterior or right posterior ducts in the common, left, or even the cystic duct. Biliary complications are the leading cause of postoperative morbidity after LDLT. 5 In cadaveric full-size liver transplantation, the incidence of biliary complications varies between 5 and 30%, 6 but as much as 50% is reported for segmental grafts. 7 End-to end microanastomosis is the preferred technique for bile duct reconstruction between the right hepatic duct (RHD) of the living donor liver graft and the recipient's bile duct, 8 although a Rouxen-Y hepaticojejunostomy (HJ) is an alternative. If more than 1 right duct is present in the graft and they are as close as 5 mm or less, bench ductoplasty can be performed before the implantation of the graft in the recipient, still allowing a unique duct-to duct anastomosis. If they are detached, multiple duct-to-duct anastomoses or more than 1 Roux-en-Y HJ must be done. In the case of a conventional distribution of the biliary tree, but a short RHD (usually Ͻ1 cm), 2 right ducts are usually obtained after the harvest of the right lobe. 9 The choice of duct anastomosis is not only dependent Abbreviations: LDLT, living donor liver transplantation; Mn-DPDP, mangafodipir trisodium; MR, magnetic resonance; MRC, magnetic resonance cholangiography; T2, transversal relaxation time; LLD, living liver donor; T1, longitudinal relaxation time; OC, operative cholangiography; RHD, right hepatic duct; HJ, hepaticojejunostomy; LHD, left hepatic duct; RPSD, right posterior sectorial duct; RASD, right anterior sectorial duct.From the

Using multivariate logistic regression analysis, probabilities of death after complicated abdominal wall hernia surgery are increased in patients with: age over 70 years, high ASA class, and associated intestinal resection. Guidelines should be developed to improve prognosis in these patients.

BackgroundThe liver is one of the most frequently damaged organs when abdominal trauma occurs. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 143 patients with liver injury treated in a single institution.MethodsA retrospective study of the patients admitted with the diagnosis of liver trauma was performed from 1992-2008. The patients were classified according to the intention to treatment: Group I, operative management; Group II, conservative management. Variables analyzed included demographic data, injury classification, associated lesions, surgical treatment, transfusions, morbi-mortality, and hospital stay. We established two periods (1992-1999; 2000-2008) in order to compare diagnosis and management.ResultsA total of 143 patients were analyzed. Thirty-one percent correspond to severe injuries. Conservative treatment was followed in 60.8 % with surgery undertaken in 14.9 % of patients from this group due to failure of conservative treatment. Immediate surgery was carried out in 38.2 %. Total mortality was 14 %. Morbidity (35.7-38.5 %) in the group of immediate surgery and failure of conservative management is similar, but not in mortality (28.6-15.4 %). In the second group (2000-2008) there are more patients with conservative treatment, with a low percentage of failure of this treatment and morbi-mortality.ConclusionsConservative treatment is an adequate treatment in a great number of patients. Failure of conservative treatment did not show a higher incidence of complications or mortality but it should be performed in centers with experienced surgeons.

No abstract

Temperature is a key parameter in organ preservation that has been consistently linked to primary nonfunction (PNF). In this communication, and for the first time anywhere, continued and direct measurements of human liver intraparenchymal temperatures are reported in six clinical cases of orthotopic liver transplantations (OLT). These measurements cover the entire transplantation procedure and include the full transport phase. In contrast with long-held beliefs, these data demonstrate that liver allograft temperatures reach and stabilize at near 0 degrees C, instead of 4 degrees C, during transport using standard protocols. Furthermore, these low temperatures do not appear to contribute to graft failure when negative factors such as long preservation, the presence of hepatic steatosis, or advanced donor age are present. The clinical and experimental implications of these findings, together with other relevant elements derived from the direct and continuous monitoring of human liver allograft intraparenchymal temperatures, are discussed.