Glissonian approach has been described as a selective vascular clamping procedure during hepatectomy based on external anatomical landmarks. Anatomical variations of the right Glissonian pedicle have been identified with an increased risk of clamping failure during Glissonian approach. The objective of this study was to characterize the anatomical variations of the right Glissonian pedicle at risk of clamping failure during right hepatectomy. This was a retrospective analysis of abdominal multiphasic CT and routine 3D reconstruction (n = 346). Anatomical variations at risk of clamping failure were Types 1 to 3 (Madoff's classification) and an angle of less than 50 between the portal vein and the left portal vein. Primary objective was the risk of right Glissonian pedicle clamping failure. Secondary objectives were the rate of normal anatomy, the rate of variations, and the rate of incomplete or extended clamping. Normal anatomy was found in 245 patients (71%). Anatomical variations were as follows: Type 1: 11%, Type 2: 17%, Type 3: 0.8%, Type 4: 0%. Angle variation less than 50 was observed in 4.5%. The risk of selective clamping failure was 34%. Extension of clamping was observed in 16%, while incomplete clamping was observed in 17.8%. Failure of right Glissonian pedicle clamping was predictable in 34% of cases while 71% of patients presented normal portal vein anatomy. Clin. Anat. 32:328-336, 2019.
a mong complications after surgery for rectal cancer, anastomosis leak is the most frequent. Coloanal anastomosis prolapse is a rare entity; a systematic review of the literature reports a rate <8% of mucosal neorectal prolapse. [1][2][3][4] this video (see Video, supplemental Digital Content 1, http://links.lww.com/DCR/a226) shows a perineal sigmoidectomy in a 70-year-old man with a side-to-end handsewn coloanal anastomosis prolapse that happened 2 years after chemoradiation and laparoscopic proctectomy with total mesorectum excision for low rectal cancer (ypt2n1m0R0). the most important symptom was pain and fecal incontinence leading to a reduction of daily activities. no particular preoperative imaging was mandatory apart from the oncological follow-up by a Ct scan. the procedure began with a mucosal section around the coloanal anastomosis. the colon was lowered, but the bottom of the anastomosis was attached in the pelvis, avoiding its mobilization. the colon was thus sectioned at the edge of the serosa to avoid vascular arcade injury. the prolapse was resected, and a new side-to-end coloanal anastomosis was performed. six months after the procedure, there was no evidence of prolapse recurrence, and the surgery significantly improved the patient's quality of life.
and of readmissions (RR 1.23, 95%-CI: 1.04e1.45, p=0.01) was increased for patients with intraperitoneal drain compared to patients without following pancreatic resection. Conclusion: This meta-analysis revealed no difference in mortality but an increased risk for postoperative morbidity, POPF and readmissions of patients with intraperitoneal drains after pancreatic resection. Therefore, the indication for intraperitoneal drains should be critically weighed in patients undergoing pancreatic resections.
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