Hacia la mortalidad cero en las resecciones hepáticas. Presentación de 200 casos consecutivos

Robles, R; Marín, Caridad; Fernández, José Antonio López; Ramı́rez, Pablo; Sánchez‐Bueno, Francisco; Morales, Dadonim Vila; Luján, Juan; Abellán, Beatriz; Ramirez, María I.; Cascales, Pedro; Pérez, Domingo; Parrilla, Pascual

doi:10.1016/s0009-739x(05)70879-4

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…that allow thorough knowledge regarding lesion size, location, and relations to intrahepatic vascular and biliary structures, as well as liver function. The above leads to a significant decrease in postoperative morbidity, as evidenced by a number of scientific papers (20)(21)(22). The clearest example of reduced morbidity in liver surgery is living-donor liver transplantation, where a liver portion (usually from a relative) is transplanted to a receiver.…”

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Liver hydatidosis in the present decade

Hidalgo

Ferrero

Perea

et al. 2011

Rev. esp. enferm. dig.

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Liver hydatidosis, a parasitic endemic disease affecting extensive areas in our planet, has been for decades a topic of debate in multiple medical and surgical forums because of its incidence, nonspecific symptoms, and diagnostic modalities, as well as the surgical procedures devised to solve this condition.On the other hand the relevant complications that may arise with disease progression and may involve multiple organs and neighboring structures causing disruption, migration, contamination, etc., turned this disease into a significant stigma within medicine, enrolling healthcare providers (veterinarians, internists, radiologists, surgeons, etc.) who for decades attempted to reduce its incidence, find better diagnostic modalities, control its spreading, and provide new therapies in order to achieve a more optimistic view of the problem.In our country, endemic areas existed for many years where incidence and prevalence rates were high, which was reported in a 1987 publication including over 7000 surgically-treated liver hydatidosis cases, the largest series reported in the medical literature worldwide to that day (1).New diagnostic procedures (ultrasounds, scanners), new anti-parasitic therapies (albendazole), and novel surgical procedures (PAIR, radical surgery) emerged over the years, which have clarified and significantly improved long-term results (2,3).In the first report (1) of surgical treatment data, conservative surgery (marsupialization, lay-open, partial cystectomy, etc.) represented 65% of cases, and was associated with high morbidity. Mortality (2.3%) was similar for both radical and conservative surgery.Several years later, in a smaller series of patients by Servicio Nacional de Salud hospitals, radical surgery was 72.7% and conservative procedures had boiled down to 28%. Mortality for conservative surgery persisted around 2% and was nil for radical surgery (4).In the last few years hydatidosis has considerably changes in many respects, from diagnostic strategies to treatment approaches (2,3), not forgetting new presentation forms and complications. The development of clinical therapy guidelines (5) and of evidence-based medicine (6) has spread among the medical community concepts that we all should bear in mind when suggesting an elective therapy for this condition.New diagnostic modalities (ultrasonography, 3D scanner, MRI, ability to assess liver function, etc.) have led to new considerations and added accuracy to both cyst and liver functional assessment, providing new ideas for effective treatment. In this respect, this same issue of our Journal includes a retrospective study assessing the possibility of leaving selected (asymptomatic) liver cysts untreated with only followup (7). As it is a retrospective, observational review, its scientific value is hardly relevant given its limitations and small number of patients; however, it represents an interesting viewpoint to be considered in a near future. Liver hydatidosis in the present decade61130-0108/2011/103/9/445-447 REVISTA ESPAÑOLA DE ENF...

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confidence: 99%

“…entails no or little morbidity and mortality (20,21) based not only on refined surgical techniques but also diagnostic tests (volume CT, MRI, angiography, etc.) that allow thorough knowledge regarding lesion size, location, and relations to intrahepatic vascular and biliary structures, as well as liver function.…”

mentioning

confidence: 99%

Liver hydatidosis in the present decade

Hidalgo

Ferrero

Perea

et al. 2011

Rev. esp. enferm. dig.

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“…In open surgery we always use a central venous pressure (CVP) of less than 4 mmHg [13]. With laparoscopic surgery we maintained a CVP of 8-10 mmHg in the first seven resections to minimise the risk of gas embolism [14].…”

Section: Anaesthetic Management and Postoperative Follow-upmentioning

confidence: 99%