Bile Leakage and Liver Resection

Capussotti, Lorenzo; Ferrero, Alessandro; Viganò, Luca; Sgotto, Enrico; Muratore, Andrea; Polastri, Roberto

doi:10.1001/archsurg.141.7.690

Cited by 196 publications

(211 citation statements)

References 13 publications

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“…Fibrin glue (Tissucol; Baxter) was applied to decrease bile leakage [22]. A careful examination was performed for about 45 min after completed resection.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound-guided liver resection: Early experience in a district general hospital

Grondona

Meola

Floris

et al. 2008

Journal of Ultrasound

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KEYWORDSIntraoperative ultrasonography; Liver resection; Hepatocellular carcinoma; Liver metastases.Abstract Introduction: Intraoperative ultrasonography (IOUS) is the gold standard for tumor staging and operative decision making in liver surgery. Providing dynamic information on tumorevessel relationships and distribution of intrahepatic veins, IOUS is also an important support for guiding the resection. Few authors report an extensive use of IOUS-guidance as a safe and effective approach. The aim of this study is to investigate the short-term results of an early experience of ultrasound (US) guided liver resection. Methods: From December 2005 to December 2007 an extensive use of IOUS-guided resection was applied in 11 consecutive patients (8 males and 3 females; median age 74 years). Perioperative data were collected prospectively to assess the influence of this approach on mortality, morbidity and early recurrence. Results: Four patients had hepatocellular carcinoma, 4 liver metastases, 1 peripheral cholangiocarcinoma, 1 hemangioma and 1 inflammatory pseudotumor. A median of 1 (range: 1e4) nodule per patient was resected. Median lesion size was 44 mm. Liver procedures included: 3 wedge resections, 3 subsegmentectomies, 4 segmentectomies and 3 bisegmentectomies. Median blood loss was 235 ml. Median surgical margin in cancer patients was 5 mm (range: 1e12). An average of 1 unit of blood transfusion was administered in 5 patients. Median postoperative hospital stay was 9 days. There was no mortality. Major complications occurred in 1 patient and minor complications in 5 patients. During a median follow-up of 14 months no recurrences were observed. Conclusions: In this study, use of IOUS-guided liver resection performed in a district general hospital proved to be a safe and effective approach in terms of short-term outcome.Sommario Premessa: Nell'ambito della chirurgia epatica l'ecografia intraoperatoria svolge un ruolo ben codificato nella stadiazione e nella pianificazione della strategia operatoria. L'importanza dell'ampio utilizzo di questa metodica anche durante la resezione è stata riportata solo da alcuni autori. Questo studio ha come scopo di verificare quali siano i risultati a breve termine di un ampio utilizzo dell'ecografia durante la resezione stessa in un ospedale periferico. Metodi: Nell'arco di 24 mesi 11 pazienti consecutivi sono stati sottoposti a resezione epatica ecoguidata. I dati perioperatori sono stati raccolti in modo prospettico per valutare l'influenza di questa metodica sulla mortalità, morbidità e recidive locali. * Corresponding author. via Peschiera 40/7, 16122 Genova, Italia.E-mail address: pietrogrondona@yahoo.com (P. Grondona). Risultati: Otto pazienti erano maschi. Età mediana 74 anni. Quattro HCC, 4 metastasi, 1 colangiocarcinoma periferico, 1 emangioma, 1 pseudotumore infiammatorio. Sono state eseguite 3 resezioni a cuneo, 3 subsegmentectomie, 4 segmentectomie e 3 bisegmentectomie. La perdita ematica mediana è stata 235 ml. In caso di tumore il margine di exeresi mediano è st...

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“…Fibrin glue (Tissucol; Baxter) was applied to decrease bile leakage [22]. A careful examination was performed for about 45 min after completed resection.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound-guided liver resection: Early experience in a district general hospital

Grondona

Meola

Floris

et al. 2008

Journal of Ultrasound

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“…Cerrahi tekniklerde izlenen gelişmelere rağmen, başta biliyer sı-zıntı olmak üzere tümör rezeksiyonu yapılan olgularda görülen biliyer sistem komplikasyonlarında anlamlı azalma izlenmemektedir. Bu nedenle özellikle genişletilmiş rezeksiyon uygulanacak olgularda olası biliyer sistem varyasyonlarının preoperatif radyolojik değerlen-dirmesi büyük önem taşır [38].…”

Section: Biliyer Anatomi Ve Varyasyonlarunclassified

Karaciğerin ve Safra Yollarının Radyolojik Anatomisi

Başak¹,

Akan²

2016

Trd Sem

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“…Bile leakage is an important complication occurring after liver surgery and its reported incidence ranges between 4.8%-7.6% in large series [89][90][91][92][93][94][95] and is less common in surgery for CRLM than for HCC or CCA. The International Study Group of Liver Surgery has recently proposed a uniform definition of bile leakage and a grading system according to severity, which is based on drain fluid bilirubin concentration of greater than three times the serum despite early attempted correction with clotting factors; (3) abdominal ascites (drainage volumes > 500 mL/d); and (4) encephalopathy with hyperbilirubinemia and exclusion of other acute confusional states [36] .…”

Section: Bile Leaksmentioning

confidence: 99%

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

Farid

Prasad²,

Morris‐Stiff³

2013

WJGS

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Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients. Core tip: Applied anatomy as used in hepatic surgery is different to the traditional morphological teaching. Applied hepatic anatomy is complex but trainees require an understanding of the basic principles to allow an appreciation of the operations performed. Complications require a low threshold of suspicion as they often have important consequences in relation to patient outcome. Recognition of such with rapid alerting of senior staff can facilitate timely and effective management. To date, no universal protocol exists for management of the post-operative period and varies from centre to centre. We provide a practical overview of the terminology, post-operative management, and complications associated with hepatic surgery.

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Bile Leakage and Liver Resection

Cited by 196 publications

References 13 publications

Ultrasound-guided liver resection: Early experience in a district general hospital

Ultrasound-guided liver resection: Early experience in a district general hospital

Karaciğerin ve Safra Yollarının Radyolojik Anatomisi

Operative terminology and post-operative management approaches applied to hepatic surgery: Trainee perspectives

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