BackgroundGallbladder carcinoma is a rare high malignancy neoplasm. The incidence of intra or post-operative incidental gallbladder carcinoma diagnosis is estimated between 0,2 and 2,8%. Primary aim of our study is to evaluate incidental gallbladder carcinoma's incidence in our experience.MethodsWe retrospectively reviewed our Surgery Division's experience about the totality of laparoscopic cholecystectomies with post-operative histological evidence of incidental gallbladder cancer. We evaluated patients' characteristics, surgical related variables, histological response, surgivcal radicalization characteristics and surgical outcome.ResultsIn the considered sample we observed 7 accidental gallbladder adenocarcinomas in post-operative histological examination. Pathological results were:1 pT1b N0 (G1), 2 pT2 N0 (G2), 2 pT2 N1 (G3b), 2 pT3 N1 (G3b) (Table 1). In 5 cases we performed neoplasm radicalization surgery with standard procedure revision. Two patients died before radicalization. Median global survival was 34 months.ConclusionWith the increase of laparoscopic cholecystectomies both elective and urgent performed in our centre we observed also an increase of incidentally diagnosed gallbladder neoplasms. Early diagnosis, meticulous peri-operative study and accurate surgical strategy are essential factors to obtain good results in incidental gallbladder cancer.
BackgroundWe aimed to analyze outcomes of early and delayed laparoscopic cholecystectomy in the elderly in our General Surgery Division.MethodsWe analyzed 114 LC performed from the 1st of January 2008 to the 31st of December 2012 in our General Surgery division: 67 LC were performed for gallbladder stones and 47 for acute cholecystitis.Results and discussionComparison between Ordinary and Emergency groups showed that drain placement and post-operative hospital stay were significatively different. There were no significative differences between Early Laparoscopic Emergency Cholecystectomy (E-ELC) and Delayed Laparoscopic Emergency Cholecystectomy (D-ELC). There weren't any differences about Team's evaluation.ConclusionWe consider LC a safe and effective treatment for cholelitiasis and acute cholecystitis in Ordinary and Emergency setting, also in the elderly. We also demonstrate that, in our experience, LC for AC is feasible as well.
The advent of machine perfusion is deeply changing the field of liver transplantation (LT), unveiling a spectrum of unexplored possibilities, both with hypothermic and normothermic perfusion. The renewed interest for these techniques originated from the necessity of improving preservation of grafts from extended criteria donors, which are now commonplace in everyday clinical practice. Hypothermic oxygenated machine perfusion (HOPE) has been associated with improved outcomes in grafts from donation after circulatory death (DCD) or grafts from extended criteria donation after brain death (DBD) donors. (1,2) As opposed to adult LT, the use of extended criteria donors seems much more limited in pediatric LT. Pediatric recipients are generally allocated whole grafts from pediatric donors or the left lateral segment resulting from the splitting of otherwise optimal grafts or living donation. In these scenarios, static cold storage generally allows satisfactory graft preservation.However, extended criteria donors are not exclusive of adult LT, and HOPE could also find specific indications in pediatric LT. Recently, the Groningen group (3) reported the successful transplantation of a graft from a pediatric DCD donor after dual hypothermic oxygenated machine perfusion (D-HOPE; ie, perfusion from both the portal vein and hepatic artery). During the procedure, the pressure settings were lowered as compared with those usually adopted in adults to avoid damaging the graft from excessive perfusion pressure, which has been observed in the experimental setting. (4) In this case, however, the graft weight was 1500 g, thus not representative of an average pediatric graft.After having gathered experience with D-HOPE for grafts from adult donors, (1) we recently applied this technique in 2 small-sized whole liver grafts from pediatric donors whose liver function tests were consistent with acute liver injury, confirming the safety and feasibility of D-HOPE also in the pediatric LT setting. Patient Presentation PAtient 1The donor was a drowned 13-year-old male with anoxic brain damage following 10 minutes of cardiac arrest and 40 minutes of unsuccessful resuscitation, who was admitted the day before he was declared brain dead. Height and weight were 170 cm and 65 kg, respectively. When he was proposed as a potential organ donor, liver function tests were consistent with acute liver injury: aspartate aminotransferase (AST), 966 IU/L (475 IU/L on admission); alanine aminotransferase (ALT), 504 IU/L (385 IU/L on admission); total bilirubin, 1.01 mg/dL (0.3 mg/dL on admission); and international normalized ratio (INR), 2.25 (1.53 on admission). Sodium level was 151 mg/dL. Blood pressure was maintained with 0.01 µg/kg/minute norepinephrine and 0.02 µg/kg/ minute epinephrine. The liver was accepted, but given Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; DBD, donation after brain death; DCD, donation after circulatory death; D-HOPE, dual hypothermic oxygenated machine perfusion; GRWR, graft-to-recipient weig...
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