Speciality
Spotlight

   




   

Surgery


   

 





Liver
Failure

    

  • Henricus BAC Stockmann, Coen A
    Hiemstra, et al  (The
    Department of Surgery, University Hospital Dijkzigt
    and Erasmus University, Rotterdam, The Netherlands)



    Extracorporeal
    Perfusion for the Treatment of Acute Liver Failure

    Annals of Surgery 231(4), 460-470.

       

    Because
    of the life-threatening complications of Acute Liver
    Failure, 75% die within a few days of onset. 
    At present there is no satisfactory treatment
    for this condition except liver transplantation.
    Though this operation has a 70-80%, 5 year
    survival rate, there is a shortage of donor organs. Therefore several temporary liver assisting therapies have been
    developed. This
    article reviews the various forms of temporary liver
    support as well as the immunologic and metabolic
    developments toward a solution for this problem.

      

    The
    authors conclude that renewed interest has developed
    in the various methods of temporary liver support from
    the early haemodialysis, haemofiltration, exchange
    transfusion, plasma exchange, resin haemoperfusion and
    charcoal perfusion to the bioartificial liver, extra
    corporeal liver assist device and extracorporeal whole
    liver perfusion. The
    immunologic implications and metabolic developments
    have also been discussed.

        

    The
    clinical improvement though temporary, allows life to
    be prolonged. New
    developments in the field of genetic modification and
    tissue engineering await clinical application in the
    near future.

          

  • Bjorg
    Tilde Fevang, Jonas Fevang, Lodve Stangeland, et al
    (The Department of Surgery, Haukeland University
    Hospital, University of Bergen, Bergen, Norway)

    Complications
    and Death After Surgical Treatment of 
    Small Bowel Obstruction

    A 35-Year Institutional Experience

    Annals of Surgery, April 2000, 231(4), 529-537.

        

    This
    study was conducted to determine the factors
    influencing  complications
    and mortality after surgery for small bowel
    obstruction using multifactorial statistical methods.

        

    877
    patients who underwent 1007 operations for small bowel
    obstruction (SBO) between 1961 and 1995 were studied
    retrospectively. 
    Patients with paralytic ileus, intussusception
    and abdominal cancer were excluded.

        

    43%
    were caused by adhesions and 41% were due to
    incarcerated hernias. Whereas
    the incidence of adhesions has increased with time but
    the incidence of hernias has dropped.
    The proportion of women has increased over the
    years. The
    overall incidence of viable strangulation was 26% and
    non-viable strangulation was 16%.
    62% had a previous laparotomy like
    gynecological surgery, appendectomies and a small
    percentage had GI surgery done on them.

          

    30%
    of patients had co-morbidity in the form of
    cardiovascular disease, lung disease, diabetes and
    central nervous system disease.

          

    The
    results showed that old age co-morbidity, non-viable
    strangulation, and a delay in treatment for more than
    24 hours were associated with an increased mortality.
    The rate of non-viable strangulation increased
    with age. The
    need for repeat surgery also increased morbidity and
    mortality. The
    overall death and complication rates decreased from
    1961 to 1995.

         

  • Ronnie
    Tung-Ping Poon, Sheung-Tat Fan, et al (The Centre of
    Liver Diseases, Department of Surgery and Pathology,
    The University of Hong Kong Medical Centre, Queen Mary
    Hospital, Hong Kong, China).

    Significance
    of Resection Margin in Hepatectomy for Hepatocellular
    Carcinoma.

    A Critical Reappraisal

    Annals of Surgery, April 2000, 231(4), 544-551.

          

    This study evaluates the influence of the width
    and the histologic involvement of the resection margin
    on postoperative recurrence after resection of
    hepatocellular carcinoma (HCC).

         

    288
    patients with macroscopically complete resection of
    HCC were divided into 2 groups with narrow (< 1cm)
    or wide (
    ³
    1cm) resection margins, and compared.

         

    The
    recurrence rates were similar between the two groups
    and they were similar in other clinicopathologic
    variables.

         

    Most
    recurrences occurred away from the resection margin or
    at multiple sites. Those
    who had histologically involved resection margin or
    venous tumour emboli or multisatellites had higher
    recurrence rates then those without.

         

    However,
    a positive histologic margin was not a significant
    risk factor for recurrence by multivariate analysis.
    The tumour stage and the perioperative
    transfusion were the only independent risk factor.

          

    They
    conclude that the width of the resection margin did
    not influence the post-operative recurrence rate after
    hepatectomy for HCC. Most
    recurrences were considered to arise from venous
    dissemination.      



 

   

Speciality Spotlight

   

   
Surgery
   

 

Liver Failure
    

  • Henricus BAC Stockmann, Coen A Hiemstra, et al  (The Department of Surgery, University Hospital Dijkzigt and Erasmus University, Rotterdam, The Netherlands)
    Extracorporeal Perfusion for the Treatment of Acute Liver Failure
    Annals of Surgery 231(4), 460-470.
       
    Because of the life-threatening complications of Acute Liver Failure, 75% die within a few days of onset.  At present there is no satisfactory treatment for this condition except liver transplantation. Though this operation has a 70-80%, 5 year survival rate, there is a shortage of donor organs. Therefore several temporary liver assisting therapies have been developed. This article reviews the various forms of temporary liver support as well as the immunologic and metabolic developments toward a solution for this problem.
      
    The authors conclude that renewed interest has developed in the various methods of temporary liver support from the early haemodialysis, haemofiltration, exchange transfusion, plasma exchange, resin haemoperfusion and charcoal perfusion to the bioartificial liver, extra corporeal liver assist device and extracorporeal whole liver perfusion. The immunologic implications and metabolic developments have also been discussed.
        
    The clinical improvement though temporary, allows life to be prolonged. New developments in the field of genetic modification and tissue engineering await clinical application in the near future.
          

  • Bjorg Tilde Fevang, Jonas Fevang, Lodve Stangeland, et al (The Department of Surgery, Haukeland University Hospital, University of Bergen, Bergen, Norway)
    Complications and Death After Surgical Treatment of  Small Bowel Obstruction
    A 35-Year Institutional Experience
    Annals of Surgery, April 2000, 231(4), 529-537.
        
    This study was conducted to determine the factors influencing  complications and mortality after surgery for small bowel obstruction using multifactorial statistical methods.
        
    877 patients who underwent 1007 operations for small bowel obstruction (SBO) between 1961 and 1995 were studied retrospectively.  Patients with paralytic ileus, intussusception and abdominal cancer were excluded.
        
    43% were caused by adhesions and 41% were due to incarcerated hernias. Whereas the incidence of adhesions has increased with time but the incidence of hernias has dropped. The proportion of women has increased over the years. The overall incidence of viable strangulation was 26% and non-viable strangulation was 16%. 62% had a previous laparotomy like gynecological surgery, appendectomies and a small percentage had GI surgery done on them.
          
    30% of patients had co-morbidity in the form of cardiovascular disease, lung disease, diabetes and central nervous system disease.
          
    The results showed that old age co-morbidity, non-viable strangulation, and a delay in treatment for more than 24 hours were associated with an increased mortality. The rate of non-viable strangulation increased with age. The need for repeat surgery also increased morbidity and mortality. The overall death and complication rates decreased from 1961 to 1995.
         

  • Ronnie Tung-Ping Poon, Sheung-Tat Fan, et al (The Centre of Liver Diseases, Department of Surgery and Pathology, The University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China).
    Significance of Resection Margin in Hepatectomy for Hepatocellular Carcinoma.
    A Critical Reappraisal
    Annals of Surgery, April 2000, 231(4), 544-551.
          
    This study evaluates the influence of the width and the histologic involvement of the resection margin on postoperative recurrence after resection of hepatocellular carcinoma (HCC).
         
    288 patients with macroscopically complete resection of HCC were divided into 2 groups with narrow (< 1cm) or wide (
    ³ 1cm) resection margins, and compared.
         
    The recurrence rates were similar between the two groups and they were similar in other clinicopathologic variables.
         
    Most recurrences occurred away from the resection margin or at multiple sites. Those who had histologically involved resection margin or venous tumour emboli or multisatellites had higher recurrence rates then those without.
         
    However, a positive histologic margin was not a significant risk factor for recurrence by multivariate analysis. The tumour stage and the perioperative transfusion were the only independent risk factor.
          
    They conclude that the width of the resection margin did not influence the post-operative recurrence rate after hepatectomy for HCC. Most recurrences were considered to arise from venous dissemination.      

 

By |2022-07-20T16:43:37+00:00July 20, 2022|Uncategorized|Comments Off on Liver Failure

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