Objectives: Liver transplant performed for hepatocellular carcinoma must adhere to criteria for the size and number of focal hepatic lesions to lower the incidence of recurrence and achieve survival rates comparable to patients transplanted for other indications. Since the Milan criteria were established in 1996, there have been many less restrictive criteria yielding similar results. Our aim was to identify the prognostic factors for patient survival and for recurrence of hepatocellular carcinoma for patients within and beyond the Milan criteria.
Background: Although open repair, preferably with mesh has long been the standard approach for ventral and incisional hernias repair, laparoscopic repair is becoming increasingly popular among surgeons and patients following the development of minimally invasive techniques. Laparoscopic ventral hemia repair may be associated with fewer complications decreased length of hospital stay and lower recurrence rates.The aim of this comparative study is to evaluate the outcome and benefits of laparoscopic over conventional ventral and incision hernia repair.Methods: The study was conducted in Surgery Department Faculty of Medicine Fayoum University, on forty patients with incisional and primary ventral hernias with defect size more than 3cm, from September 2009 to December 2011. Patients were randomly selected and allocated into two groups using coin and flip method, Group A included twenty patients operated on by laparoscopy and Group B included twenty patients who underwent open surgical repair.Results: Both groups had nearly similar demographics and clinical data. The procedure was successfully completed in all patients of both groups, with no mortality or conversion to open procedure in group A The mean diameter of hernia defect was 5.6 cm in group A, compared to 6.1 cm in group B. Polypropylene mesh was used for all patients in group B and in group A different types of composite mesh was used.There was a significant decrease in the need for postoperative analgesia in group A compared to group B (P value <0.05).The study showed less complications and shorter hospital stay in group A, with no recurrence in both groups during a period of follow up for two years.Conclusion: Laparoscopic ventral and incisional hernia repair is safe, effective and technically feasible approach with statistically significant reduction in postoperative morbidity, earlier recovery and shorter hospital stay and with similar recurrence rate to the conventional open group.
Objectives: To analyze the effect of human leukocyte antigen tissue typing on outcome of livedonor liver transplant. Materials and Methods: Fifty recipients underwent live-donor liver transplant in the Dar Al-Fouad Hospital in Egypt and were retrospectively evaluated. Patients were classified into 2 groups: those with human leukocyte antigen +ve, and those with human leukocyte antigen -ve and donors. Hepatitis C virus-related end-stage liver disease was the main indication for transplant. Demographic data, preoperative laboratory data, results of human leukocyte antigen tissue typing, Child score, model for end-stage liver disease score, graft/recipient weight-ratio, ischemia times, surgical complications, postoperative laboratory data, liver biopsy, immunosuppression, and pulse steroids were collected. Graft and patient survivals were studied using Kaplan-Meier curves. Results: The mean model end-stage liver disease score was 18 ± 3.61 in group 1 and 17.73 ± 3.72 in group 2, with no significant difference. Graft/recipient weight ratio, ischemia times, and postoperative complications showed P = NS. Cyclosporine and tacrolimus were used in 5/9, 8/41, and 4/9 in group 1, and 32/41 in group 2 (P = NS). Rejection and pulse steroids were reported in 3/9 and 12/41 of group 1, and 3/12 and 11/41 of group 2 (P = NS). Hepatitis C virus-recurrence was diagnosed in 5/9 of patients (55%) and 8/41 of patients (29.5%) in groups 1 and 2 (P < .05). No statistical difference was found regarding mortality; 5-year patient and graft survival was 35/50 (70% in group 1 [human leukocyte antigen +ve]), 7/9 (77.8%), and 28/41 in group 2 (68.3%) (human leukocyte antigen -ve). Conclusions: Positive human leukocyte antigen typing before live-donor liver transplant has no effect on the incidence of postoperative complications, rejection episodes, and patient or graft survival. Recipients with positive human leukocyte antigen typing may have increased risk of hepatitis C virus-recurrence after live-donor liver transplant.
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