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Biliary reconstruction with flexible endo-stent in liver transplantation
e280
Electronic Poster Abstracts
EP01D-052 BILIARY RECONSTRUCTION WITH FLEXIBLE ENDO-STENT IN LIVER TRANSPLANTATION A. Rossano Garcia, H. S. Diliz Perez, D. Fernandez-Angel and L. Garcia-Covarrubias Trasplantation Department, Hospital General de Mexico, Mexico Introduction: Reconstruction of the bile duct in liver transplantation represents 30% of the morbidity. The most important complications are leakage and stenosis. Despite advances in the management of these complications still remains a major challenge. Methods: Retrospective, open and descriptive review of medical records of liver transplant patients from July 2011 to April 2015. Results: 23 liver transplants from deceased donors: 13 women and 10 men, average age 45.9 years. The median waiting list time was 8 months. Indication were: HCV 9, primary biliary 10, alcohol 4. MELD score at listing: 15 points. In 16 used Piggy back and 7 classic technique, operating time: 8 hours. In 19 patients we placed a flexible stent Flexima model from Boston Scientific length 10 cm 7FR diamater choledoco-choledocal in a termino-terminal fashion. We dilated the sphincter of Oddi with a biliary canula and secure the distal part of the stent in its intaduodenal position; inserting the proximal end of the stent to the bile duct of the graft. Endoprosthesis was removed 15 to 21 post-transplant days with immediate endoscopic cholangiography with previous liver function tests and abdominal x-ray. 2 patients spontaneously expelled the stent, 14 were discharged the day after withdrawal. 2 had pain, 4 hyperamylasemia, none leakage or stenosis. Conclusions: We consider it a safe and effective method to reduce biliary complications associated with liver transplantation and ease removal of the stent by endoscopy and radiological control of the bile duct and in our experience has proven to have low incidence of complications.
EP01D-053 INITIAL EXPERIENCE OF LAPAROSCOPIC MAJOR HEPATECTOMY H. J. Choi and I. Y. Park Surgery (HPB), Bucheon St. Mary’s Hospital, Catholic University of Korea, Republic of Korea Background: Laparoscopic liver resection is becoming increasingly common. However, laparoscopic major hepatectomy (MH) is still limited to a few high volume hepatobiliary centers. After we gained enough experience in open hepatectomies and various laparoscopic surgeries, we started the laparoscopic MH. Methods: We performed six laparoscopic MH from January 2015 to May 2015. Among 6 patients, we performed 4 laparoscopic left hepatectomies and 2 laparoscopic right hepatectomies. We used individual technique for inflow control in laparoscopic left hepatectomies and
Glissonean technique in laparoscopic right hepatectomies. All parenchymal dissections were performed by cavitron ultrasonic surgical aspirator (CUSA). Pringles maneuver and hanging method were not performed. Results: Mean age of patients was 53.8 years and three patients were women. Among 6 patients, 3 patients had hepatocellular carcinoma, 2 patient had intrahepatic duct stone and 1 patient had symptomatic hemangioma. Two patients had liver cirrhosis. Mean operation time was 240 minutes (210 w 280) for laparoscopic left hepatectomy and 350 minutes (300 w 400) for laparoscopic right hepatectomy. Mean estimated blood loss was 240 mL (110 w 350) for laparoscopic left hepatectomy and 500 mL for laparoscopic right hepatectomy. No transfusion was needed in all six patients during operation. There was no open conversion among 6 patients. And there was no severe postoperative complication except for pleural effusion or fluid collection at the hepatectomy site. Conclusion: Laparoscopic MH still remains a challenging procedure requiring important experience in both laparoscopy and liver surgery. However, we get used to both laparoscopy and liver surgery, we are able to try laparoscopic MH cautiously.
EP01D-054 MAJOR HEPATECTOMY USING THE GLISSONEAN APPROACH IN TWO PATIENTS WITH RIGHT UMBILICAL PORTION Y. Ome, Y. Kawamoto, K. Hashida, Y. Nagahisa, K. Yamaguchi, M. Okabe, S. Okamoto, K. Kawamoto, T. Park and T. Ito Surgery, Kurashiki Central Hospital, Japan Introduction: Right umbilical portion (RUP) is a rare congenital anomaly. The presence of RUP is associated with anomalous ramification of the hepatic artery, portal vein, and biliary system, so major hepatectomy is complicated and requires a careful approach. Methods: The first patient underwent right anterior sectionectomy for intrahepatic cholangiocarcinoma in segment 8. We encircled the several Glissonean pedicles running into the right anterior section at the right side of RUP. We temporarily clamped each pedicle, confirmed the demarcation area, and finally ligated and cut them. The operation succeeded without injuring vessels intended to be preserved. The second patient underwent left trisegmentectomy for perihilar chonangiocarcinoma. After cutting the inferior common bile duct, we encircled and secured the right lateral Glissonean pedicle with tape. The portal vein, the hepatic artery, and the hilar plate were separated from the other structures proximal to the secured Glissonean pedicle. The vessels running in the pedicle should be preserved, and the other vessels and contents should be resected. Identifying the vessels to be preserved facilitated the safe lymphadenectomy and dissection of the vessels to be resected. We successfully performed left trisegmentectomy despite aberrant vessels and an anomalous anatomy. Results: In both cases, hepatectomy was successfully performed without any complications. Only twenty one hepatectomy cases with RUP have been reported in the
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
EP01D-052 BILIARY RECONSTRUCTION WITH FLEXIBLE ENDO-STENT IN LIVER TRANSPLANTATION A. Rossano Garcia, H. S. Diliz Perez, D. Fernandez-Angel and L. Garcia-Covarrubias Trasplantation Department, Hospital General de Mexico, Mexico Introduction: Reconstruction of the bile duct in liver transplantation represents 30% of the morbidity. The most important complications are leakage and stenosis. Despite advances in the management of these complications still remains a major challenge. Methods: Retrospective, open and descriptive review of medical records of liver transplant patients from July 2011 to April 2015. Results: 23 liver transplants from deceased donors: 13 women and 10 men, average age 45.9 years. The median waiting list time was 8 months. Indication were: HCV 9, primary biliary 10, alcohol 4. MELD score at listing: 15 points. In 16 used Piggy back and 7 classic technique, operating time: 8 hours. In 19 patients we placed a flexible stent Flexima model from Boston Scientific length 10 cm 7FR diamater choledoco-choledocal in a termino-terminal fashion. We dilated the sphincter of Oddi with a biliary canula and secure the distal part of the stent in its intaduodenal position; inserting the proximal end of the stent to the bile duct of the graft. Endoprosthesis was removed 15 to 21 post-transplant days with immediate endoscopic cholangiography with previous liver function tests and abdominal x-ray. 2 patients spontaneously expelled the stent, 14 were discharged the day after withdrawal. 2 had pain, 4 hyperamylasemia, none leakage or stenosis. Conclusions: We consider it a safe and effective method to reduce biliary complications associated with liver transplantation and ease removal of the stent by endoscopy and radiological control of the bile duct and in our experience has proven to have low incidence of complications.
EP01D-053 INITIAL EXPERIENCE OF LAPAROSCOPIC MAJOR HEPATECTOMY H. J. Choi and I. Y. Park Surgery (HPB), Bucheon St. Mary’s Hospital, Catholic University of Korea, Republic of Korea Background: Laparoscopic liver resection is becoming increasingly common. However, laparoscopic major hepatectomy (MH) is still limited to a few high volume hepatobiliary centers. After we gained enough experience in open hepatectomies and various laparoscopic surgeries, we started the laparoscopic MH. Methods: We performed six laparoscopic MH from January 2015 to May 2015. Among 6 patients, we performed 4 laparoscopic left hepatectomies and 2 laparoscopic right hepatectomies. We used individual technique for inflow control in laparoscopic left hepatectomies and
Glissonean technique in laparoscopic right hepatectomies. All parenchymal dissections were performed by cavitron ultrasonic surgical aspirator (CUSA). Pringles maneuver and hanging method were not performed. Results: Mean age of patients was 53.8 years and three patients were women. Among 6 patients, 3 patients had hepatocellular carcinoma, 2 patient had intrahepatic duct stone and 1 patient had symptomatic hemangioma. Two patients had liver cirrhosis. Mean operation time was 240 minutes (210 w 280) for laparoscopic left hepatectomy and 350 minutes (300 w 400) for laparoscopic right hepatectomy. Mean estimated blood loss was 240 mL (110 w 350) for laparoscopic left hepatectomy and 500 mL for laparoscopic right hepatectomy. No transfusion was needed in all six patients during operation. There was no open conversion among 6 patients. And there was no severe postoperative complication except for pleural effusion or fluid collection at the hepatectomy site. Conclusion: Laparoscopic MH still remains a challenging procedure requiring important experience in both laparoscopy and liver surgery. However, we get used to both laparoscopy and liver surgery, we are able to try laparoscopic MH cautiously.
EP01D-054 MAJOR HEPATECTOMY USING THE GLISSONEAN APPROACH IN TWO PATIENTS WITH RIGHT UMBILICAL PORTION Y. Ome, Y. Kawamoto, K. Hashida, Y. Nagahisa, K. Yamaguchi, M. Okabe, S. Okamoto, K. Kawamoto, T. Park and T. Ito Surgery, Kurashiki Central Hospital, Japan Introduction: Right umbilical portion (RUP) is a rare congenital anomaly. The presence of RUP is associated with anomalous ramification of the hepatic artery, portal vein, and biliary system, so major hepatectomy is complicated and requires a careful approach. Methods: The first patient underwent right anterior sectionectomy for intrahepatic cholangiocarcinoma in segment 8. We encircled the several Glissonean pedicles running into the right anterior section at the right side of RUP. We temporarily clamped each pedicle, confirmed the demarcation area, and finally ligated and cut them. The operation succeeded without injuring vessels intended to be preserved. The second patient underwent left trisegmentectomy for perihilar chonangiocarcinoma. After cutting the inferior common bile duct, we encircled and secured the right lateral Glissonean pedicle with tape. The portal vein, the hepatic artery, and the hilar plate were separated from the other structures proximal to the secured Glissonean pedicle. The vessels running in the pedicle should be preserved, and the other vessels and contents should be resected. Identifying the vessels to be preserved facilitated the safe lymphadenectomy and dissection of the vessels to be resected. We successfully performed left trisegmentectomy despite aberrant vessels and an anomalous anatomy. Results: In both cases, hepatectomy was successfully performed without any complications. Only twenty one hepatectomy cases with RUP have been reported in the
HPB 2016, 18 (S1), e1ee384