Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. the aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). material and methods. Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. Results. Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), andBrought to you by | MIT Libraries Authenticated Download Date | 5/11/18 7:58 AM
The severity of hepatic steatosis is modulated by genetic variants, such as patatin-like phospholipase domain containing 3 (PNPLA3) rs738409, transmembrane 6 superfamily member 2 (TM6SF2) rs58542926, and membrane-bound O-acyltransferase domain containing 7 (MBOAT7) rs641738. Recently, mitochondrial amidoxime reducing component 1 (MTARC1) rs2642438 and hydroxysteroid 17-beta dehydrogenase 13 (HSD17B13) rs72613567 polymorphisms were shown to have protective effects on liver diseases. Here, we evaluate these variants in patients undergoing bariatric surgery. A total of 165 patients who underwent laparoscopic sleeve gastrectomy and intraoperative liver biopsies and 314 controls were prospectively recruited. Genotyping was performed using TaqMan assays. Overall, 70.3% of operated patients presented with hepatic steatosis. NASH (non-alcoholic steatohepatitis) was detected in 28.5% of patients; none had cirrhosis. The increment of liver fibrosis stage was associated with decreasing frequency of the MTARC1 minor allele (p = 0.03). In multivariate analysis MTARC1 was an independent protective factor against fibrosis ≥ 1b (OR = 0.52, p = 0.03) and ≥ 1c (OR = 0.51, p = 0.04). The PNPLA3 risk allele was associated with increased hepatic steatosis, fibrosis, and NASH (OR = 2.22, p = 0.04). The HSD17B13 polymorphism was protective against liver injury as reflected by lower AST (p = 0.04) and ALT (p = 0.03) activities. The TM6SF2 polymorphism was associated with increased ALT (p = 0.04). In conclusion, hepatic steatosis is common among patients scheduled for bariatric surgery, but the MTARC1 and HSD17B13 polymorphisms lower liver injury in these individuals.
IntroductionGastroesophageal reflux disease (GERD) is recognized as one of the most common disorders of the upper gastrointestinal tract (GIT). The best choice of management for advanced GERD is laparoscopic surgery.AimTo compare and evaluate the results of surgical treatment of GERD patients operated on using two different techniques.Material and methodsBetween 2001 and 2012, 353 patients (211 female and 142 male), aged 17–76 years (mean 44), underwent laparoscopic antireflux surgery. The study included patients who underwent a Toupet fundoplication or Wroblewski Tadeusz procedure (WTP).ResultsThe mean age of the group was 47.77 years (17–80 years). Forty-nine (32.45%) patients had severe symptoms, 93 (61.58%) had mild symptoms and 9 (5.96%) had a single mild but intolerable sign of GERD. Eighty-six (56.95%) patients had a Toupet fundoplication and 65 (43.04%) had a WTP. The follow-up period was 18–144 months. The average operating time for Toupet fundoplication and the WTP procedure was 164 min (90–300 min) and 147 min (90–210 min), respectively. The perioperative mortality rate was 0.66%. The average post-operative hospitalization period was 5.4 days (2–16 post-operative days (POD) = Toupet) vs. 4.7 days (2–9 POD = WTP). No reoperations were performed. No major surgical complications were identified.ConclusionsWroblewski Tadeusz procedure due to a low percentage of post-operative complications, good quality of life of patients and a zero recurrence rate of hiatal hernia should be a method of choice.
breakdown by RUCA codes: 53% (788) urban, 30% (449) suburban, and 17% (261) rural. Odds of LT were higher for urban-dwellers (OR1.33, 95%CI[1.07e1.65]). Likelihood of LT was also impacted by distance from TC: 72% (258/ 355) of urban-dwellers <50 miles from TC were transplanted vs. 54% (81/151) >200 miles (OR 2.3, 95%CI [1.55-3.42]; p< 0.0001). Listed rural area patients were also more likely to be transplanted if they lived closer to TC (57% <100 miles vs. 36% >200miles; p = 0.0328). Urban dwellers living >200 miles from TC had better odds of being transplanted than rural dwellers living <50 miles from TC (54% vs. 36.2%; OR 2.04, 95%CI[1.09e3.81]; p = 0.0303). There was no difference in patient and graft survival in LT recipients between the subgroups. Conclusion: Listed patients living in urban-areas are more likely to be transplanted than those in rural-areas. Likelihood of LT for urban and rural patients increases with proximity to LT-center. Once transplanted, outcomes are not impacted by geographic variation.
Background: According to the Tokyo Guidelines 2013 (TG13), the management of Grade II acute cholecystitis (AC) is not consensual. Our aim was to compare laparotomy to laparoscopy for grade II AC using Propensity score adjustment analysis. Methods: Our study is retrospective, including 448 patients operated for grade II AC according to TG13. Patients were divided into two groups: 231 patients operated by laparoscopy (group A) and 217 patients operated by laparotomy (group B). Both of these groups were comparated before and after adjustment using the Propensity score. Results: Before adjustment patients in group B were older than patients in group A, with a higher rate of patients suffering from heart disease; white blood cell count and total bilirubin were higher in group B; there were more thickening of the gallbladder wall at ultrasonography in group B and the rate of gangrenous cholecystitis was higher in group B. These factors were considered as confusing. After computation of this PS, area under the ROC curve of the model was 80.9% AE0.033, suggesting its good performance. After the adjustment, there were no significant differences between the two groups for the confusing factors. The morbidity, the mortality and the reoperation rate were similar in the two groups. The duration of hospital stay and the direct medical costs were significantly higher in group B. Conclusion: Patients with grade II AC should be operated using laparoscopic approch since their hospitalisation is shorter and without significant complications.
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