Grafts used in Domino liver transplantation (LT) obtained from living donor liver transplantation (LDLT)for familial amyloid polyneuropathy (FAP) patients have been mainly used as reduced grafts. Because of small-for-size problems seen in LDLT, using whole liver grafts could improve post-LT outcome. Eight consecutive Domino LDLT using whole livers without retrohepatic inferior vena cava (IVC) from FAP patients were retrospectively analyzed. The graft weight/recipient's body weight ratio (GWRW) in the domino recipients ranged from 1.28% to 2.4% (mean: 1.52). Multiple vascular reconstructions in the whole-liver domino LT resulted in longer than usual warm ischemia time (mean: 64 min); however immediate post-operative recovery of hepatic function was uneventful. At 8-40 months after the transplant, all the FAP patients are well and all of the domino recipients are alive. Domino LT using a whole FAP liver from a LDLT for a FAP patient presents satisfactory results, even though the transplant procedure is technically complicated.

Liver transplantation was effective for CNS manifestations of cerebral amyloid angiopathy associated with amyloidogenic transthyretin Tyr114Cys.

Background : Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach. Aim: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis. Method: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place. Result : This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient´s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution. Conclusions : Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.

Purpose: The present study aimed to determine whether the percentage of bleeding complications differs between the right and the left approaches in percutaneous biliary drainage (PBD) in adult patients.Materials and Methods: This was a prospective, descriptive, nonrandomized comparative and longitudinal study. We included adult patients over 18 years of age who underwent a PBD. We excluded those with a bilateral PBD for the comparative study. Usually, but not exclusively, we performed the right approach under fluoroscopic guidance and the left one under ultrasound and fluoroscopy.Results: Of 150 cases, 63 were performed using the right approach and 61 with the left; 26 were performed with the bilateral. The right approach faced less dilated biliary ducts and more benign diseases. We experienced 20 bleeding complications (13.33%, confidence intervals of 95% = 8.3-19.8), 7 in the bilateral approach, 10 in the right approach, and 3 in the left one. The difference between the right and the left approaches was statistically significant (Fisher P = 0,04). No procedures were required to obtain hemostasis, and only one patient (0.66%, confidence intervals of 95% = 0.009-3.66) (in the right side) required a red blood cell transfusion. We found no related mortality.Conclusions: Global bleeding complications are more likely to appear in the right approach in which less dilated biliary ducts and more benign diseases probably contributed to a higher number of needle passes, portal and hepatic vein punctures, and, therefore, to an increase in the risk of bleeding complications. The significant bleeding complication rate was low (0.66%).

Background: The risk of bile duct injury (BDI) during cholecystectomy remains a concern, despite efforts proposed for increasing safety. The Critical View of Safety (CVS) has been adopted promoting to reduce its risk. Aim: To perform a survey to assess the awareness of the CVS, estimating the proportion of surgeons that correctly identified its elements and its relationship with BDI. Methods: An anonymous online survey was sent to 2096 surgeons inquiring on their common practices during cholecystectomy and their knowledge of the CVS. Results: A total of 446 surgeons responded the survey (21%). The percentage of surgeons that correctly identified the elements of CVS was 21.8% and 24.8% among surgeons claiming to know the CVS. The percentage of surgeons that reported BDI was higher among those that incorrectly identified the elements of the CVS (p=0.03). In the multivariate analysis, career length was the most significant factor related to BDI (p=0.002). Conclusions: The percentage of surgeons that correctly identified the Critical View of Safety was low, even among those who claimed to know the CVS. The percentage of surgeons that reported BDI was higher among those that incorrectly identified the elements of the CVS.

140 Background: A “Palliative Medicine Day Care Unit” (PMDCU) program began in January of 2014 as part of the services provided by the Department of Palliative Medicine in a national hospital in Costa Rica; the program allows patients with hemato-oncological diseases to continue as outpatients while receiving inpatient treatment for their refractory symptoms. This study analyses patient consult rates, results and the dynamics of the unit during its first year in service. Methods: The statistical information of patients attended in the PMDCU, were collected during the period between January and December of 2014. The data included: the population characteristics, the nature of the care provided and the interaction with other departments. Results: A total of 1311 patients were examined in the PMDCU, for a total of 1609 consultations; on average each patient had 3.6 consultations. The average time patients spent with physicians during consultation or receiving treatment were 115 minutes. The most common patient diagnosis was gastrointestinal, gynecological, and prostate cancers. After the initial consult, 63% of patients continued treatment in the outpatient clinic of the same hospital, 34% were scheduled for follow-up consultations in the PMDCU, 2.4% of patients were referred to the Emergency Department and less than 2% of patients were either admitted to the hospital or were referred to other palliative care units. Treatment in the PMDCU included, analgesia treatment administration, paracentesis, thoracocentesis, parenteral nutrition, blood transfusions and patient and family education. Conclusions: The PMDCU has had acceptance among patients with a high number of consultations and adequate follow up of patients. The most common types of cancer diagnosis were gastrointestinal, gynecological and prostate cancers. The majority of patients examined, continued treatment in either the outpatient clinic or follow up in the PMDCU; few were referred to the emergency department. The PMDCU provides treatment that would normally be administered either in an inpatient setting or in the emergency department, but avoiding the extra cost and inconvenience to the patients and their family.