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A modified technique for elective inguinal hernia repair in cirrhotic patients with ascites: Improving the outcome
e276
Electronic Poster Abstracts
EP01D-038 A MODIFIED TECHNIQUE FOR ELECTIVE INGUINAL HERNIA REPAIR IN CIRRHOTIC PATIENTS WITH ASCITES: IMPROVING THE OUTCOME H. Shoreem, I. Ayoub, O. Hegazy, S. Saleh, T. Yassein, H. Soliman and K. Abou El-ella HBP Surgery and Liver Transplantation Department, Menoufia University, National Liver Institute, Egypt Background: Inguinal hernia repair in patients with decompensated liver cirrhosis is fraught with wound complication such as persistent ascetic leak. As a result, surgeons are reluctant to operate on cirrhotic patients for fear of putting the patient at increased risk. The goal of this study is to evaluate a modified technique aiming to decrease postoperative ascetic leak in such patients. Method: Over one year from April 2014 to April 2015, 20 patients were operated prospectively at National Liver institute, Menoufeya University using a new “non-herniotomy, sac reduction” modified technique, which is a modification of Lichtenstein hernia repair technique, done by complete reduction of the sac after dissection from the inguinal cord (without herniotomy) then narrowing of internal ring over prolene mesh plug. These patients (group 1) and compared with another 20 patients previously operated upon using the traditional technique and considered as (group 2). Results: Patients using modified technique (group 1) showed no ascitic leak in comparison to 4 cases (20%) in the group 2 with herniotomy (p < 0.001) and lower incidence of wound seroma 1 case (5%) in group 1 in comparison to 3 cases (15%) in group 2. There is also lowering in hospital stay in group 1 than group 2 Conclusion: This modified “non-herniotomy” technique is applicable to inguinal hernia in cirrhotic patients with extremely significant decrease of ascitic leak and it is highly recommended to be used in ascitic patients. A large prospective randomized study is needed to verify these initial results.
EP01D-039 EVALUATION OF THE THUNDERBEATÔ DEVICE IN HEPATIC RESECTION F. Alie-Cusson, B. T. Do, Y. Collin, M. Plasse, M. Dagenais, R. Létourneau, A. Roy, S. Turcotte, R. Lapointe and F. Vandenbroucke-Menu Département de Chirurgie Hépato-Biliaire et Pancréatique, Centre Hospitalier Universitaire de Montréal, Canada Objective: The ThunderbeatÔ is a new device combining bipolar energy and ultrasonic technologies. The purpose of this study is to evaluate this device in hepatic surgery. Methods: This was a retrospective review of the last 204 patients operated for liver resection between June 2012 and December 2013 with either ThunderbeatÔ (Th) or LigasureÔ (Li). Groups were matched according to the following criteria: sex, diagnosis and procedure. Results: Both groups were comparable in terms of age, personal medical history and diagnosis. Operative time (201 min Th vs 191 min Li), estimated blood loss (EBL) (580 cc Th vs 523 cc Li) or R0 resection (91 Th vs 87 Li)
were not statistically different between both groups. Mortality rate was 0.98% (1 patient died in each group). Overall severe complication rate (Clavien-Dindo grade 3 or more) was 7.8% in each group (p = 1.000). Biliary leak (17 Th vs 14 Li), post-operative bleeding/hematoma (3 Th vs 4 Li) and abscess formation (11 Th vs 14 Li) were not statistically different between devices. Post-operative liver function tests (ALT = 244 Th vs 196 Li, bilirubin = 26 Th vs 20 Li) and INR (1.16 Th vs 1.18 Li) were similar in both groups. Conclusion: For hepatic resection, the use of the ThunderbeatÔ device seems to be as safe and efficient as the LigasureÔ device. Post-operative bleeding and biliary leak rate does not differ in a statistically significant way between both devices.
EP01D-040 SURGICAL TREATMENT OF PRIMARY LIVER CANCER WITH DIAPHRAGMATIC MUSCLE INVASION H. Chen, S. Sun and J. Li Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, China Introduction: To explore the feasibility and the afterward curative effect of surgical treatment of primary hepatic carcinoma with diaphragmatic invasion, this essay sums up the experiences of surgical treatment. Methods: Clinical data of 37 patients with primary hepatic carcinoma who had diaphragmatic invasion and had liver surgery in Anhui Provincial Hospital between January 2008 and January 2014 were retrospectively analyzed, choosing the same line as a control group of 54 cases of patients with liver cancer randomly. Results: All cases were performed successfully, no significant statistical differences were found between pre-operation clinical data of two groups. The operation time of the group with diaphragmatic invasion is slightly longer than that of the group without (149.4 23.4 min vs 137.9 24.6 min, P = 0.028); meanwhile, there is no obvious difference between bleeding loss of the two groups (449.5 304.1 ml vs 304.1 222.3 ml, P = 0.499). There are no significant statistical differences in other aspects between two groups of patients: postoperative pulmonary infection, pleural effusion, infection of incision, mortality and hospitalization time. Based on Kaplan Meier e log-rank test analysis, it is found that the two groups had no significant differences in disease-free survival and overall survival. Conclusions: Hepatic carcinoma with diaphragmatic invasion is still the indications for liver resection and should not be treated as indicator of poor prognosis of liver cancer. It is safe and effective along with some diaphragm excision.
EP01D-042 LAPAROSCOPIC VERSUS OPEN LIVER RESECTION FOR HCC: PRELIMINARY CASE-MATCHED ANALYSIS R. Dalla Valle, G. Perrone, E. Bertocchi, E. Bonati, F. Montali and M. Iaria Department of Surgery, Division of General Surgery and Organ Transplantation, Parma University Hospital, Italy
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
EP01D-038 A MODIFIED TECHNIQUE FOR ELECTIVE INGUINAL HERNIA REPAIR IN CIRRHOTIC PATIENTS WITH ASCITES: IMPROVING THE OUTCOME H. Shoreem, I. Ayoub, O. Hegazy, S. Saleh, T. Yassein, H. Soliman and K. Abou El-ella HBP Surgery and Liver Transplantation Department, Menoufia University, National Liver Institute, Egypt Background: Inguinal hernia repair in patients with decompensated liver cirrhosis is fraught with wound complication such as persistent ascetic leak. As a result, surgeons are reluctant to operate on cirrhotic patients for fear of putting the patient at increased risk. The goal of this study is to evaluate a modified technique aiming to decrease postoperative ascetic leak in such patients. Method: Over one year from April 2014 to April 2015, 20 patients were operated prospectively at National Liver institute, Menoufeya University using a new “non-herniotomy, sac reduction” modified technique, which is a modification of Lichtenstein hernia repair technique, done by complete reduction of the sac after dissection from the inguinal cord (without herniotomy) then narrowing of internal ring over prolene mesh plug. These patients (group 1) and compared with another 20 patients previously operated upon using the traditional technique and considered as (group 2). Results: Patients using modified technique (group 1) showed no ascitic leak in comparison to 4 cases (20%) in the group 2 with herniotomy (p < 0.001) and lower incidence of wound seroma 1 case (5%) in group 1 in comparison to 3 cases (15%) in group 2. There is also lowering in hospital stay in group 1 than group 2 Conclusion: This modified “non-herniotomy” technique is applicable to inguinal hernia in cirrhotic patients with extremely significant decrease of ascitic leak and it is highly recommended to be used in ascitic patients. A large prospective randomized study is needed to verify these initial results.
EP01D-039 EVALUATION OF THE THUNDERBEATÔ DEVICE IN HEPATIC RESECTION F. Alie-Cusson, B. T. Do, Y. Collin, M. Plasse, M. Dagenais, R. Létourneau, A. Roy, S. Turcotte, R. Lapointe and F. Vandenbroucke-Menu Département de Chirurgie Hépato-Biliaire et Pancréatique, Centre Hospitalier Universitaire de Montréal, Canada Objective: The ThunderbeatÔ is a new device combining bipolar energy and ultrasonic technologies. The purpose of this study is to evaluate this device in hepatic surgery. Methods: This was a retrospective review of the last 204 patients operated for liver resection between June 2012 and December 2013 with either ThunderbeatÔ (Th) or LigasureÔ (Li). Groups were matched according to the following criteria: sex, diagnosis and procedure. Results: Both groups were comparable in terms of age, personal medical history and diagnosis. Operative time (201 min Th vs 191 min Li), estimated blood loss (EBL) (580 cc Th vs 523 cc Li) or R0 resection (91 Th vs 87 Li)
were not statistically different between both groups. Mortality rate was 0.98% (1 patient died in each group). Overall severe complication rate (Clavien-Dindo grade 3 or more) was 7.8% in each group (p = 1.000). Biliary leak (17 Th vs 14 Li), post-operative bleeding/hematoma (3 Th vs 4 Li) and abscess formation (11 Th vs 14 Li) were not statistically different between devices. Post-operative liver function tests (ALT = 244 Th vs 196 Li, bilirubin = 26 Th vs 20 Li) and INR (1.16 Th vs 1.18 Li) were similar in both groups. Conclusion: For hepatic resection, the use of the ThunderbeatÔ device seems to be as safe and efficient as the LigasureÔ device. Post-operative bleeding and biliary leak rate does not differ in a statistically significant way between both devices.
EP01D-040 SURGICAL TREATMENT OF PRIMARY LIVER CANCER WITH DIAPHRAGMATIC MUSCLE INVASION H. Chen, S. Sun and J. Li Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, China Introduction: To explore the feasibility and the afterward curative effect of surgical treatment of primary hepatic carcinoma with diaphragmatic invasion, this essay sums up the experiences of surgical treatment. Methods: Clinical data of 37 patients with primary hepatic carcinoma who had diaphragmatic invasion and had liver surgery in Anhui Provincial Hospital between January 2008 and January 2014 were retrospectively analyzed, choosing the same line as a control group of 54 cases of patients with liver cancer randomly. Results: All cases were performed successfully, no significant statistical differences were found between pre-operation clinical data of two groups. The operation time of the group with diaphragmatic invasion is slightly longer than that of the group without (149.4 23.4 min vs 137.9 24.6 min, P = 0.028); meanwhile, there is no obvious difference between bleeding loss of the two groups (449.5 304.1 ml vs 304.1 222.3 ml, P = 0.499). There are no significant statistical differences in other aspects between two groups of patients: postoperative pulmonary infection, pleural effusion, infection of incision, mortality and hospitalization time. Based on Kaplan Meier e log-rank test analysis, it is found that the two groups had no significant differences in disease-free survival and overall survival. Conclusions: Hepatic carcinoma with diaphragmatic invasion is still the indications for liver resection and should not be treated as indicator of poor prognosis of liver cancer. It is safe and effective along with some diaphragm excision.
EP01D-042 LAPAROSCOPIC VERSUS OPEN LIVER RESECTION FOR HCC: PRELIMINARY CASE-MATCHED ANALYSIS R. Dalla Valle, G. Perrone, E. Bertocchi, E. Bonati, F. Montali and M. Iaria Department of Surgery, Division of General Surgery and Organ Transplantation, Parma University Hospital, Italy
HPB 2016, 18 (S1), e1ee384