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Background: Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. Methods: The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. Results: Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. Conclusion: The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplantation (KTx) necessarily conveys an ischemia/reperfusion (I/R) process, which impacts on allograft outcomes. Delayed graft function (DGF) is defined as a non-decrease of serum creatinine by at least 10% daily on 3 consecutive days during the first 7 days post-KTx. DGF significantly conditions both short- and long-term graft outcomes. Still there is a lack of DGF predictive biomarkers. Objectives: This study aimed to explore the potential of kidney graft perfusate metabolomics to predict DGF occurrence. Methods: 49 human perfusates from grafts categorized upon donor type [donation after brain death (DBD)/donation after circulatory death (DCD)] and DGF occurrence and 19 perfusates from a murine model classified upon death type (DBD/DCD) were collected and analyzed by NMR-based metabolomics. Results: The multivariate analysis of the murine data highlighted significant differences between perfusate metabolomes of DBD versus DCD. These differences were similarly observed in the human perfusates. After correcting for the type of donor, multivariate analysis of human data demonstrated a metabolomics signature that could be correlated with DGF occurrence. Conclusions: The metabolome of kidney grafts is influenced by the donor’s type in both human and pre-clinical studies and could be correlated with DGF in the human DBD cohort. Thus, metabolomic analysis of perfusate applied prior to KTx may represent a new predictive tool for clinicians in a more personalized management of DGF. Moreover, our data paves the way to better understand the impact of donor’s types on the biochemical events occurring between death and the hypothermic storage. [ABSTRACT FROM AUTHOR]

Background: Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). Method: Members of the European–African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. Results: Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). Conclusion: Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome. [ABSTRACT FROM AUTHOR]

Background: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. Methods: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. Results: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. Conclusion: PVE/HVE achieved betterFLR hypertrophy and resectability than PVE in this collaborative experience. [ABSTRACT FROM AUTHOR]

Background Results of donation after circulatory death ( DCD) liver transplantation are impaired by graft loss, resulting mainly from non-anastomotic biliary stricture. Donor age is a risk factor in deceased donor liver transplantation, and particularly in DCD liver transplantation. At the authors' institute, age is not an absolute exclusion criterion for discarding DCD liver grafts, DCD donors receive comfort therapy before withdrawal, and cold ischaemia is minimized. Methods All consecutive DCD liver transplantations performed from 2003 to 2012 were studied retrospectively. Three age groups were compared in terms of donor and recipient demographics, procurement and transplantation conditions, peak laboratory values during the first post-transplant 72 h, and results at 1 and 3 years. Results A total of 70 DCD liver transplants were performed, including 32 liver grafts from donors aged 55 years or less, 20 aged 56-69 years, and 18 aged 70 years or more. The overall graft survival rate at 1 month, 1 and 3 years was 99, 91 and 72 per cent respectively, with no graft lost secondary to non-anastomotic stricture. No difference other than age was noted between the three groups for donor or recipient characteristics, or procurement conditions. No primary non-function occurred, but one patient needed retransplantation for artery thrombosis. Biliary complications were similar in the three groups. Graft and patient survival rates were no different at 1 and 3 years between the three groups ( P = 0·605). Conclusion Results for DCD liver transplantation from younger and older donors were similar. Donor age above 50 years should not be a contraindication to DCD liver transplantation if other donor risk factors (such as warm and cold ischaemia time) are minimized. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking.Methods: A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients' clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis.Results: Fifty-three surgeons consecutively and anonymously included 1,089 patients in this prospective study. A primary open approach was chosen in 74 patients (6.8%), whereas a laparoscopic approach was the first option in 1,015 patients (93.2%). Independent predictive factors for a primary open approach were previous history of upper abdominal surgery [odds ratio (OR) 4.13, p < 0.001], patient age greater than 70 years (OR 2.41, p < 0.05), surgeon with more than 10 years' experience (OR 2.08, p = 0.005), and gangrenous cholecystitis (OR 1.71, p < 0.05). In the laparoscopy group, 116 patients (11.4%) required conversion to laparotomy. Overall, 38 patients (3.5%) presented biliary complications and 49 had other local complications (4.5%). Incidence of bile duct injury was 1.2% in the whole series, 2.7% in the open group, and 1.1% in the laparoscopy group. Sixty patients had general complications (5.5%). The overall mortality rate was 0.8%. All patients who died were in poor general condition [American Society of Anesthesiologists (ASA) III or IV].Conclusions: Although laparoscopic cholecystectomy is currently considered as the standard treatment for acute cholecystitis, an open approach is still a valid option in more advanced disease. However, overall mortality and incidence of bile duct injury remain high. [ABSTRACT FROM AUTHOR]

PURPOSE: Nowadays laparoscopic colorectal surgery has demonstrated its advantages, including reduced postopera- the pain, decreased duration of ileus, and shorter hospital stay. Few studies report results of laparoscopic surgery in complicated diverticulitis. This study was designed to ana- lyze the results of laparoscopic sigmoidectomy in patients with fistulized sigmoiditis. METHODS: The authors retro- spectively reviewed 16 patients who had laparoscopic sigmoidectomy for fistulized diverticulitis between 1992 and 2003 in a series of 247 laparoscopic colectomies. Eleven patients presented with colovesical, four with colovaginal, and one with colocutaneous fistulas; all were caused by sigmoiditis. The procedure always consisted of celioscopic sigmoidectomy with stapled trasanal suture and, when in- dicated, closure of the cystic or vaginal fistula orifice. RE- SULTS: Mean age was 60 (range, 39–78) years. Mean number of episodes of diverticulitis before operation was three (range, 1–5). Mean time between the last episode and operation was 46 (range, 2–250) weeks. In our first three yeats of experience, three cases (18.7 percent) were converted to laparotomy. Reasons for conversion were the necessity for intestinal resection, splenectomy, and a wound of the ante- rior rectum. The mean operative time was 172 (range, 100– 280) minutes. Mean hospital stay was 5.7 (range, 3–12) days. There was no mortality. Postoperative morbidity (2– patients, 12.5 percent) consisted of one pulmonary infection and one splenectomy. Long-term follow-up revealed no recurrence of diverticulitis and one incisional hernia. CONCLUSIONS: In experienced hands, laparoscopic sigmoidectomy may be a safe and effective procedure for fistulized sigmoiditis. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. Background: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. Methods: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. Results: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2–13 days). At a mean follow-up of 13 months (median, 10 months; range, 2–58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. Conclusions: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique. [ABSTRACT FROM AUTHOR]

Lumped models are frequently used to provide a satisfactory descriptionof the hemodynamic properties of the pulmonary vasculature. The purpose ofthis study is to describe a method to identify simultaneously the parametersvalues of windkessel models components. The following equation was used toobtain R[sub 1] (characteristic resistance), R[sub 2] (peripheralresistance), C (total compliance) and L (inertance): For formulae see full text. where k[sub i] are the following functions of L, R[sub 1] , R[sub 2] and C: For formulae see full text. To assess the accuracy of the method, estimates of R[sub 1] , R[sub 2] , and C were compared to characteristic impedance R[sub c] , vascularresistance PVR and pulmonary arterial compliance C[sub d] respectivelycomputed from referenced methods. Comparison between R[sub 1] and R[sub c] , PVR and R[sub 1] + R[sub 2] , C and C[sub d] were obtainedin 5 anaesthetised pigs during basal conditions and after endotoxin-shock. The results indicate that in both conditions, comparisons evidenced highlysignificant correlations between values computed by the different approaches(p < 0.0001). Although our method yielded to consistently lower valuesthan values provided by referenced methods, the results were concordant withrespect to the expected response of pulmonary vasculature to endotoxin insult.We conclude that our method of identification is suitable for the assessmentof lumped parameters windkessel model estimates. The main interest is thatactual resistance and compliance values can be obtained easily and simultaneouslyby a global method approach. [ABSTRACT FROM AUTHOR]

The coexistence of extracranial internal carotid stenosis and ipsilateral intracranial aneurysm is a rare event whose management is controversial. Theoretically, the correc tion of a significant stenosis of the extracranial internal carotid may lead to an increase in the downstream pressure in the intracranial carotid and may, consequently, increase the risk of rupture of the ipsilateral aneurysm. Moreover, dramatic increase of blood pressure is not uncommon after carotid endarterectomy and may promote aneurysmal rupture. Intracranial surgical correction of a hypoperfused aneurysm down to an extracra nial carotid stenosis should carry an increased risk of inadequate cerebral flow during the procedure, and unspecific postoperative stimulation of platelets aggregation and coagu lation may complete obstruction of a subtotal carotid stenosis. The authors describe successful treatment of 2 patients by a two-stage surgical procedure. In a first step, the intracerebral aneurysms were controlled and electively excluded by clipping. In a second step, carotid endarterectomies were performed some days later without any neurologic complications. Postoperative recoveries were uneventful, and six months after these surgical procedures, clinical examination of both patients did not reveal any worsening of the preoperative neurologic status. [ABSTRACT FROM PUBLISHER]

The coexistence of extracranial internal carotid stenosis and ipsilateral intracranial aneurysm is a rare event whose management is controversial. Theoretically, the correction of a significant stenosis of the extracranial internal carotid may lead to an increase in the downstream pressure in the intracranial carotid and may, consequently, increase the risk of rupture of the ipsilateral aneurysm. Moreover, dramatic increase of blood pressure is not uncommon after carotid endarterectomy and may promote aneurysmal rupture. Intracranial surgical correction of a hypoperfused aneurysm down to an extracranial carotid stenosis should carry an increased risk of inadequate cerebral flow during the procedure, and unspecific postoperative stimulation of platelets aggregation and coagulation may complete obstruction of a subtotal carotid stenosis. The authors describe successful treatment of 2 patients by a two-stage surgical procedure. In a first step, the intracerebral aneurysms were controlled and electively excluded by clipping. In a second step, carotid endarterectomies were performed some days later without any neurologic complications. Postoperative recoveries were uneventful, and six months after these surgical procedures, clinical examination of both patients did not reveal any worsening of the preoperative neurologic status. [ABSTRACT FROM AUTHOR]

Presents a corrected reprint of the article "Laparoscopic liver resection of benign liver tumors: Results of a multicenter European experience," by B. Descottes, D. Glineur, F. Lachachi, D. Valleix, J. Paineau, A. Hamy, M. Morino, H. Bismuth, D. Castaing, E. Savier, P. Honore, O. Detry, M. Legrand, J. S. Azagra, M. Goergen, M. Ceuterick, J. Marescaux, D. Mutter, B. de Hemptinne, R. Troisi, J. Weerts, B. Dallemagne, C. Jehaes, M. Gelin, V. Donckier, R. Aerts, B. Topal, C. Bertrand, B. Mansvelt, L. Van Krunckelsven, D. Herman, M. Kint, E. Totte, R. Schockmel, J. F. Gigot, published in the Volume 17, 2003 issue of the "Surgical Endoscopy" journal.

The ratio of mean aortic pressure and mean aortic flow does not completely describe the mechanical properties of the arterial system. Using the impedance spectrum, a shift of the resistances to the small vessels was observed while total resistance and arterial tonus were unchanged during the application of Peep. [ABSTRACT FROM AUTHOR]