Background Approximately 8300 hemophiliacs are registered in Japan, but no comprehensive reports on hepatobiliary and pancreatic surgery (HBPS) have been conducted. This report investigates the current status of HPBS in hemophilia patients in Japan. Methods The subjects were hemophiliac patients seen between January 1 2007, and December 31 2017, at facilities participating in this study among the facilities for performing high‐difficulty cases nationwide designated by the Japanese Society for HBPS. A retrospective examination of short‐term outcomes in 49 cases was conducted to assess patient background, disease, surgical procedure, and complications. Results The types of hemophilia were A: 43 cases, B: four cases, and von Willebrand disease: two cases (hemophilia severity: mild 32, moderate seven, severe 10). The target malignant diseases for surgery were hepatocellular carcinoma (HCC) in 20 cases, intrahepatic cholangiocellular carcinoma (CCC) in four cases, combined HCC‐CCC in two cases, hilar CCC in two cases, and pancreatic cancer in four cases. As for the surgical procedure, limited resection (subsegmentectomy and partial hepatectomy) was performed in 16 cases of HCC even with normal liver function tests. Pancreaticoduodenectomy and distal pacreatectomy were performed for pancreatic cancers as in the standard procedure. Postoperative complications were postoperative bleeding in two cases after hepatectomy and one after pancreatectomy in one case. When compared with Japanese National Clinical Data base, the complication rates after hepatectomy and pancreatectomy were not conspicuous in hemophilic patients. Conclusions As long as they are performed in qualified centers, complication rate is not increased in hemophilic patients undergoing HBPS.
Background/Aims: The effect of splenectomy on the liver regeneration of a partial graft after living donor liver transplantation (LDLT) is controversial. In recent years, some studies have shown that platelets have strong effects on promoting liver regeneration, but not with a smallfor-size liver graft. This study aimed to validate the effects of splenectomy on liver regeneration rate after LDLT with extended left lobe graft with the middle hepatic vein. Methodology: Of 312 LDLT to date, 32 adult patients at Nagasaki University Hospital (Nagasaki, Japan) transplanted with an extended left lobe graft with middle hepatic vein between April 2013 and April 2019 were retrospectively assessed. In our department, the preoperative platelet count indicated for splenectomy is 50,000/ L. Overall, 13 and 19 patients were included in the splenectomy and without splenectomy groups, respectively. We examined the relations hip between splenectomy and liver volume increase, and postoperative platelet count on the 1st, 3rd, 5th, and 7th postoperative day. The liver volume 1 month (1MVol) after LDLT was estimated using a 3D image analysis system. Results: ROC curve analysis showed the spleen volume threshold for significant volume increase (1MVol/graft weight 2) was 440ml. With regard to 1MVol, no significant difference was observed between the splenectomy and without splenectomy groups. However, in the splenectomy group, recipients with a large spleen (more than 440 ml) led to higher liver volume increase than in those with a small spleen. Platelet count significantly increased from postoperative day 14 in the splenectomy group regardless of the size of the spleen. Conclusions: Simultaneous splenectomy does not always have an effect on liver regeneration in extended left lobe graft LDLT. However, for LDLT recipients with large spleen volume, graft volume increase was affected, probably through vigorous portal venous blood flow but not plateletderived factors.
Background/Aim: Easy measurement of liver steatosis without pathological diagnosis may help improve donor surgery efficiency and increase the chances of organ donations. We analyzed the correlations between bioelectrical impedance (BI) in human livers, liver fat content, and pathological findings. Materials and Methods: Sixteen tumor-free liver specimens resected during elective oncological surgery were analyzed. All samples were stored in ice chilled saline before BI measurement. The BI measurement was performed using a device with the tetrapolar circuit method in which the current and voltage electrodes are independent. Liver cholesterol and triglyceride levels were investigated from the same specimen using the Soxhlet extraction method. Pathological findings were examined by counting the number of hepatocytes with fatty changes per high-power field. Results: The median liver steatosis percentage was 0.4%. The liver steatosis percentage was significantly correlated with the intrahepatic triglyceride content (r=0.82, p<0.001). Linear regression of the measurements and predicted values yielded an r 2 of 0.63 between the BI at 100 kHz and liver steatosis, indicating reasonable agreement (p<0.001). Conclusion: BI analysis is a simple, non-invasive method that can be easily applied to evaluate liver steatosis.
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