Background: Short-bowel syndrome remains the primary cause of intestinal failure (IF) in adult patients. We aim to report the long-term results of medical and surgical rehabilitation in a cohort of patients with type III IF (III-IF) and develop a formula to predict parenteral nutrition (PN) independency. Methods: We used a retrospective analysis of a prospective database for III-IF patients undergoing autologous gastrointestinal reconstruction surgery (AGIRS) from March 2006 to August 2018. Analyzed variables included demographic data, postsurgical intestinal length (PSIL), postsurgical anatomy, teduglutide (TED) treatment, and PN volume reduction. Univariate analysis, Cox regression, logistic regression forward stepwise models, and receiver operating characteristic (ROC) curve were done using SPSS v20. Results: AGIRS was performed in 88 patients. The most frequent anatomy at first visit was type 1. Prevailing anatomy after surgery was type 3. Eight patients started TED; 6 achieved freedom from PN. At a mean follow-up time of 1606.1 ± 1190.25 days, freedom from PN survival was achieved in 83%. Variables identified at the logistic regression analysis led to a novel formula to predict intestinal rehabilitation, including PSIL, presence of ileocecal valve, and use of TED as part of postsurgical treatment. Conclusions: AGIRS in this group of patients enabled intestinal length increase and also intestinal anatomy conversion into a more favorable type for intestinal rehabilitation. TED treatment was useful to discontinue PN in patients with classical negative anatomical predictors. The novel predicting formula has an ROC area under the curve = 0.82. Further studies are necessary to validate this formula.
Acute weakness may occur after LT due to various causes, DMS and US may be feasible for diagnosis of ICUAW. Early diagnosis of ICUAW may lead to earlier physiotherapy.
Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of "steal flow syndrome" cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation.
Background: The pancreas is an uncommon site for metastases, accounting for 0.25% to 5% of pancreatic tumors, so that solitary pancreatic metastases are rare. The most frequent primary tumor capable of metastasizing in the pancreas is clear cell renal carcinoma (CCRC). Surgical resection remains the best therapeutic alternative to achieve long-term survival. Our aim is to present the long-term results of a multi-center study in Argentina of pancreatic resection due to pancreatic metastases. Methods: Multi-center, retrospective report of adult patients operated for pancreatic metastases from July 2010 to December 2019, in 7 high volume Argentinian HPB surgery centers. Results: 1557 pancreatic surgeries were performed, 48 (3.1%) due to pancreatic metastases. Median age was 62±11 years, 25 (52%) male. Twenty-six distal pancreatectomies, 12 pancreatoduodenectomies, 5 total pancreatectomies, 1 central pancreatectomy and 4 tumor enucleations were performed. The most frequent primary tumor was CCRC (N=35) followed by colorectal cancer (N=4). Mean number of pancreatic lesions was 1.6±3. Twenty-two (45%) patients had complications and 5 (10%) patients required reoperation; the 90-day mortality rate was 4.2%. Mean follow-up was 80 months. The mean disease-free interval was 5.3±6 years. The disease-free and overall survival was better in patients with pancreatic metastases of clear cell renal carcinoma compared with other type of cancer. Conclusion: Despite its rarity, pancreatic metastases must be considered as a possible diagnosis in patients with a prior oncological history; surgical resection remains as the main therapeutic option.
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