A prevalência de desnutrição energético-protéica em ambiente hospitalar varia de 20% a 50%, conforme critérios utilizados. O risco nutricional se refere ao risco aumentado de morbimortalidade em decorrência do estado nutricional. A triagem nutricional identifica indivíduos desnutridos ou em risco de desnutrição, almejando determinar se existe risco nutricional e se é necessária avaliação nutricional mais detalhada. Já a avaliação nutricional, além de detectar desnutrição, classifica seu grau e permite coleta de informações que auxiliem em sua correção. Foram revisadas as ferramentas de triagem nutricional mais citadas na literatura atual. Para obtenção dos artigos de triagem nutricional foram feitas pesquisas nos websites científicos. Dentre as ferramentas citadas, ressalta-se a Nutritional Risk Screening 2002, que pode ser aplicada a todos os pacientes internados em hospitais, independentemente da doença que apresentem ou da idade, sem custo adicional ao serviço e que pode ser efetuada por diferentes profissionais. Cabe a cada profissional desenvolver senso crítico para determinar sua técnica de preferência. Termos de indexação:Assistência hospitalar. Desnutrição. Programas de rastreamento. Triagem.

Background Biliary complications remain a major cause of morbidity and mortality in liver transplantation and the biliary anastomosis technique could increase this risk. The aim of this study was to compare the effects of biliary reconstruction techniques in orthotopic liver transplantation on the incidence of biliary complications. Methods A systematic review and meta-analysis using the Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were performed comparing biliary reconstruction techniques in liver transplantation with regard to the occurrence of biliary complications. Number needed to treat (NNT) was calculated at a 95% confidence interval.Results Fifty-seven articles were selected (3 randomized clinical trials, 6 clinical trials, and 48 historical cohort studies). There was a lower risk for biliary complications (NNT = 6) using end-to-end choledochocholedochostomy (EECC) without drainage compared with EECC with drainage. The biliary complication risk was lower (NNT = 4) for sideto-side choledochocholedochostomy (SSCC) with drainage compared with SSCC without drainage. No difference was found between EECC without drainage and SSCC with drainage. Conclusions According to our results, considering the highest level of evidence available in the literature, we suggest that biliary reconstruction in liver transplantation should be performed using EECC or SSCC, without drainage in the former, and with drainage in the latter.

Hepatectomy can comprise excision of peripheral tumors as well as major surgeries like trisegmentectomies or central resections. Patients can be healthy, have localized liver disease or possess a cirrhotic liver with high operative risk. The preoperative evaluation of the risk of postoperative liver failure is critical in determining the appropriate surgical procedure. The nature of liver disease, its severity and the operation to be performed should be considered for correct preparation. Liver resection should be evaluated in relation to residual parenchyma, especially in cirrhotic patients, subjects with portal hypertension and when large resections are needed. The surgeon should assess the rationale for the use of hepatic volumetry. Child-Pugh, MELD and retention of indocyanine green are measures for assessing liver function that can be used prior to hepatectomy. Extreme care should be taken regarding the possibility of infectious complications with high morbidity and mortality in the postoperative period. Several centers are developing liver surgery in the world, reducing the number of complications. The development of surgical technique, anesthesia, infectious diseases, oncology, intensive care, possible resection in patients deemed inoperable in the past, will deliver improved results in the future.

Background: The development of internal fistulas, the obstruction of the upper gastrointestinal tract and bile ducts, pseudoaneurisms and symptomatic pseudocysts are considered rare complications of chronic pancreatitis. The aim of the study was to review the 8-year experience in the treatment of this category of patients. Methods: Retrospective analysis of the treatment results of patients with chronic pancreatitis who were treated in our institution during the period between January 2008 and June 2015. Results: Out of 135 patients, 40 were females (29.6%) and 95 e males (70.4%). Alcohol was an etiologic factor in 50 cases (37.0%). Of all patients, 52 (38.5%) suffered gastroduodenal/biliary obstruction; internal pancreatic fistulae developed in 36 (26.7%). Pseudoaneurisms of the splenic/gastroduodenal artery developed in 22 (16.3%), while symptomatic and/or infected pseudocysts e in 23 patients (17.0%). 92 patients (68.1%) underwent surgical intervention. The Frey and Beger procedure was performed in 34, cystogastro/duodenostomy in 48, external drainage and other procedures in 11, distal pancreatectomy with splenectomy in 2 patients. Conservative treatment was successful in 33 (24.5%) cases. ICU treatment was necessary for 64 patients (47.4%), a mean of 4.1 days (range 1e 19). The overall average hospital stay was 17.8 days (range 4e56), the mortality rate for the whole group was 1.5%. Conclusion: Surgical intervention is the most common treatment of rare complications of chronic pancreatitis in our institution. The Frey and Beger procedure and internal drainage are associated with low complication and mortality rate; however, minimally invasive treatment should be used more often in the future.

Aim: We report a case of pathologically confirmed complete remission of HCC induced by hepatic arterial infusion chemotherapy (HAIC). Methods: A 45-year-old male patient had a massive HCC in the right and main portal veins. He achieved a partial response after two cycles of HAIC with 5-fluorouracil (750 mg/m 2 ) and cisplatin (25 mg/m 2 ). Result: After completion of six cycles he received a curative partial hepatectomy, and histopathology revealed complete necrosis without any viable tumor cell. He has been in good health without recurrence at 40-month followup. Conclusion: This result suggests that this regimen is a promising therapeutic modality for the treatment of advanced HCC with portal vein tumor thrombosis.

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Accurate check of the inner sutures is mandatory and further stitches may be necessary to secure the anastomosis. The anterior gastrotomy is finally closed with an absorbable running suture. Finally, a further layer of sutures is applied over the posterior suture line between the gastric serosa and the pancreatic capsule.