Our study indicates that the use of APC to treat weight regain after RYGB is a safe and effective procedure and promotes a reduction in gastrojejunal anastomosis, final weight, and BMI, with a low rate of complications.
Background/Aims: Our objective is to assess donor complications in all right hepatic lobe living-donor liver transplantation (LDLT) at our center. Methods: Of a total of 352 liver transplantations performed, 60 were right-lobe LDLT. Most donors (88.3%) were related to the recipients. Results: Mean hospital stay was 5.4 8 0.6 days. No complications occurred due to preoperative evaluation. Most donors received one or two units of autologous blood transfusion. Only 5 (8.3%) needed nonautologous blood transfusion. Most complications were minor and treated conservatively. Bile leaks from the cut surface of the liver occurred in 5 donors (8.3%). Two patients had potentially fatal complications: perforated duodenal ulcer and portal vein thrombosis (PVT). The donor with perforated ulcer developed septicemia and multiple organ failure. He was discharged from the hospital with hemiparesis due to cerebral ischemia. The patient with PVT remained asymptomatic and the portal vein was recanalized by the 3rd postoperative month. One donor died in the immediate postoperative period of cardiac arrest due to cardiac arrhythmia. Conclusion: Right hepatectomy for LDLT may be associated with significant morbidity, including death and it should be performed only by surgeons with great experience.
Low levels of IGF-I and IGFBP-3 observed in patients with advanced liver cirrhosis are corrected after OLT. IGF-I and IGFBP-3 correlate negatively with MELD.
Most adult and pediatric liver transplantation candidates present several metabolic disturbances that lead to malnutrition. Because malnutrition may adversely affect morbidity and mortality of orthotopic liver transplantation, it is very important to carefully assess the nutritional status of the waiting list patients. Pretransplant nutritional therapy -- enteral or parenteral -- may positively influence liver metabolism, muscle function, and immune status. Nutrition therapy should continue in the short- and also in the long-term post-transplant periods. For malnourished patients, early post-transplant enteral or parenteral nutrition have been useful in improving nutritional status. Finally, the metabolic and nutritional care of the liver transplant donor must be considered to reduce allograft dysfunction indices.
RESUMO: Objetivo:O presente estudo tem por objetivo avaliar a anatomia arterial hepática em doadores e receptores de 150 transplantes hepáticos. Métodos: 246 pacientes foram analisados, 129 doadores e 117 receptores de fígado. Resultados: A anatomia arterial hepática era normal em 189 (76,82%) pacientes. Alterações anatômicas foram encontradas nos demais 57 (23,18%), sendo as principais: artéria hepática direita ramo da artéria mesentérica superior, artéria hepática esquerda ramo da artéria gástrica esquerda, artéria hepática direita ramo da artéria mesentérica superior associada à artéria hepática esquerda ramo da artéria gástrica esquerda e artéria hepática comum ramo da artéria mesentérica superior. Algumas anomalias raras foram visualizadas. Conclusões: Os achados deste estudo demonstram a variabilidade da anatomia do sistema arterial hepático e alertam para a necessidade de cautela nas dissecções cirúrgicas, principalmente nas captações de enxerto dos transplantes de fígado, para se evitar comprometimento do suprimento sangüíneo hepático.Descritores: Artéria hepática; Transplante hepático; Alterações anatômicas.Revista do Colégio Brasileiro de Cirurgiões -Vol. 28 -n o 1 -13
INTRODUÇÃOO estudo da artéria hepática tem sido abordado desde a Antiguidade. Vários estudiosos como Aristóteles e Rufus teceram comentários a respeito do sistema arterial hepático, porém foi Galeno o primeiro a analisar mais detalhadamente este tópico, descrevendo que as artérias destinadas ao estômago, fígado e baço não nasciam em tronco comum na aorta como a artéria destinada ao intestino, mas, ao contrário, em dois troncos distintos 1 .Andréas Versalius, no século XVI, foi o primeiro estudioso a proporcionar descrições anatômicas superiores às de Galeno, comentando sobre a divisão em dois ramos de tronco celíaco: direito -correspondente à artéria hepá-tica e esquerdo -correspondente à artéria esplênica que forneceria ramo gástrico, a artéria gástrica esquerda.No entanto, Jacques Benigne Winslow e Albert Haller, considerados os pais da angiologia moderna, definiram corretamente a anatomia do tronco celíaco -Winslow descreven-
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