Search

Copyright of British Journal of Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Indications for hepatectomy in patients with hepatocellular carcinoma (HCC) who have portal hypertension (PH) have been controversial. Some studies have concluded that PH is a contraindication to hepatectomy, whereas others have suggested that perioperative prophylactic management (PPM) can help overcome complications after hepatectomy associated with PH. The objective of this retrospective study was to assess the short‐ and long‐term outcomes after hepatectomy for HCC in patients with PH, with or without PPM. Methods: Records were reviewed of consecutive patients who underwent hepatectomy for HCC, with or without PPM of PH, in a single institution from 1994 to 2015. Patients were divided into three groups: those who received PPM for PH (PPM group), patients who had PH but did not receive PPM (no‐PPM group) and those without PH (no‐PH group). Results: A total of 1259 patients were enrolled, including 123 in the PPM group, 181 in the no‐PPM group and 955 in the no‐PH group. Three‐ and 5‐year overall survival rates were 74·3 and 53·1 per cent respectively in the PPM group, 69·2 and 54·9 per cent in the no‐PPM group, and 78·1 and 64·2 per cent in the no‐PH group (P = 0·520 for PPM versus no PPM, P = 0·027 for PPM versus no PH, and P < 0·001 for no PPM versus no PH). Postoperative morbidity and mortality rates were 26·0 and 0·8 per cent respectively in the PPM group, 29·8 and 1·1 per cent in the no‐PPM group, and 20·3 and 0 per cent in the no‐PH group. Conclusion: The present study has demonstrated acceptable outcomes among patients with HCC who received appropriate management for PH in an Asian population. Enhancement of the safety of hepatic resection through use of PPM may provide a rationale for expansion of indications for hepatectomy in patients with PH. [ABSTRACT FROM AUTHOR]

Background Splenic vein ligation may result in sinistral (left-sided) portal hypertension and gastrointestinal haemorrhage. The aim of this study was to analyse the pathogenesis of sinistral portal hypertension following splenic vein ligation in pancreaticoduodenectomy. Methods Patients who underwent pancreaticoduodenectomy for pancreatic cancer between January 2005 and December 2012 were included in this retrospective study. The venous flow pattern from the spleen and splenic hypertrophy were examined after surgery. Results Of 103 patients who underwent pancreaticoduodenectomy with portal vein resection, 43 had splenic vein ligation. There were two predominant venous flow patterns from the spleen. In the varicose route (27 patients), flow from the spleen passed to colonic varices and/or other varicose veins. In the non-varicose route, flow from the spleen passed through a splenocolonic collateral (14 patients) or a spontaneous splenorenal shunt (2 patients). The varicose route was associated with significantly greater splenic hypertrophy than the non-varicose route (median splenic hypertrophy ratio 1·52 versus 0·94; P < 0·001). All patients with the varicose route had colonic varices, and none had a right colic marginal vein at the hepatic flexure. Conclusion Pancreaticoduodenectomy with splenic vein ligation may lead to sinistral portal hypertension. To avoid the development of varices, it is important to preserve the right colic marginal vein. Reconstruction of the splenic vein should be considered if the right colic marginal vein is divided. [ABSTRACT FROM AUTHOR]

Background: Intraoperative ultrasonography (IOUS) is considered the standard for the identification of liver metastases. Use of lipid-stabilized perfluorobutane microbubbles as an ultrasound contrast agent may improve this. The value of contrast-enhanced IOUS (CE-IOUS) in enumerating colorectal liver metastases was studied here. Methods: CE-IOUS was performed in consecutive resections for colorectal liver metastases in 2007-2010. All patients underwent preoperative computed tomography. Magnetic resonance imaging was not carried out routinely. Conventional intraoperative examination including IOUS, and CE-IOUS with peripherally injected contrast were performed. The histopathological findings and 6-month follow-up images were used as the reference standard. Results: The study group of 102 patients had a total of 315 lesions identified on preoperative imaging (2·4 lesions per operation; 129 operations). Conventional intraoperative examination including IOUS identified 350 lesions (2·7 per operation). CE-IOUS identified 370 lesions (2·9 per operation). The sensitivity, specificity and accuracy of CE-IOUS were 97·1, 59·1 and 93·2 per cent respectively. The CE-IOUS findings altered the surgical plan in 19 operations (14·7 per cent). Conclusion: CE-IOUS provided additional information to that obtained using contemporary preoperative imaging and conventional intraoperative examinations. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Examines the effect of a saline-linked radiofrequency coagulator on blood loss during hepatic resection. Performance of a randomized clinical trial; Differences between the dissecting sealer and clamp crushing methods; Measurement of total intraoperative blood loss.

Shell structures in nuclear mean field potentials are analyzed using semiclassical periodic-orbit theory. r[sup α]-type potential model is taken as an approximation of Woods-Saxon model, and spin-orbit coupling is also taken into account. Using this model, we examine shell structure as functions of deformation, nuclear size (diffuseness), and spin-orbit coupling strength. Significant roles of periodic orbit bifurcations for strong deformed shell effects are clarified. Special attentions will be paid to bifurcations of the 'bridge orbits', which emerge from symmetric orbits and then submerge in other symmetric orbits by varying a potential parameter. [ABSTRACT FROM AUTHOR]

The article presents medical case of reappraisal of the usefulness of percutaneous transhepatic cholangioscopy for distal biliary strictures.

The article presents a case study of an 81-year-old man who was scheduled for surgery due to recurrent hepatocellular carcinoma (HCC) with hepatitis C. The patient was diagnosed with low-intense tumor based with the use of magnetic resonance imaging with gadolinium-etthoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA). The use of an indocyanine green-fluorescent imaging method for real-time determination of HCC during surgery is discussed.