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Background: Differentiating between benign and malignant causes of obstructive jaundice can be challenging, even with the advanced imaging and endoscopic techniques currently available. In patients with obstructive jaundice, the predictive accuracy of bilirubin levels at presentation was examined in order to determine whether such data could be used to differentiate between malignant and benign disease...
Background: In selected patients with chronic pancreatitis, extensive pancreatectomy can be effective for the treatment of intractable pain. The resultant morbid diabetes can be ameliorated with islet autotransplantation (IAT). Conventionally, islet infusion occurs intraoperatively after islet processing. A percutaneous transhepatic route in the immediate postoperative period is an alternative approach...
Purpose: To assess the role of endoscopic ultrasound (EUS) in the initial evaluation and follow‐up of incidental pancreatic cystic lesions (PCL).
Methods: Retrospective analysis of patients with incidental PCL on imaging who were evaluated by EUS and had a minimal follow‐up of 1 year.
Results: There were 62 patients (40 females and 22 males). The mean patient age was 67.7 years (range, 30–89)....
Background: As indications for liver resection expand, objective measures to assess the risk of peri‐operative morbidity are needed. The impact of sarcopenia on patients undergoing liver resection for colorectal liver metastasis (CRLM) was investigated.
Methods: Sarcopenia was assessed in 259 patients undergoing liver resection for CRLM by measuring total psoas area (TPA) on computed tomography...
Background: While commonly used to describe liver resections at risk for post‐operative complications, no standard definition of ‘major hepatectomy’ exists. The objective of the present retrospective study is to specify the extent of hepatic resection that should describe a major hepatectomy.
Methods: Demographics, diagnoses, surgical treatments and outcomes from patients who underwent a liver resection...
Background: The role of staging laparoscopy (SL) in patients with incidental gallbladder cancer (IGBC) is ill defined. This study evaluates the utility of SL with the aim of identifying variables associated with disseminated disease (DD).
Methods: Consecutive patients with IGBC who underwent re‐exploration between 1998 and 2009 were identified from a prospective database. The yield and accuracy...
Background: Most surgeons routinely place intraperitoneal drains at the time of pancreatic resection but this practice has recently been challenged.
Objective: Evaluate the outcome when pancreatic resection is performed without operatively placed intraperitoneal drains.
Methods: In all, 226 consecutive patients underwent pancreatic resection. In 179 patients drains were routinely placed at the...
Background: The feasibility of total laparoscopic pancreaticoduodenectomy (TLPD) has been established. Laparoscopic major venous resection during TLPD has not been reported. The aim of the present study was to describe the technique and outcomes of patients undergoing TLPD with major venous resection.
Methods: Retrospective review of all consecutive patients undergoing TLPD and major venous resection...
Background: A growth in the utilization of high‐risk allografts is reflective of a critical national shortage and the increasing waiting list mortality. Using risk‐adjusted models, the aim of the present study was to determine whether a volume–outcome relationship existed among liver transplants at high risk for allograft failure.
Methods: From 2002 to 2008, the Scientific Registry of Transplant...
Objectives: Defining perioperative mortality as death that occurs within 30 days of surgery may underestimate ‘true’ mortality among patients undergoing hepatic resection. To better define perioperative mortality, trends in the risk for death during the first 90 days after hepatectomy were assessed.
Methods: Surveillance, Epidemiology and End Results (SEER) Medicare data were used to identify 2597...
Background: Perihilar cholangiocarcinoma (PHCCA) remains a surgical challenge for which few large Western series have been reported. The aims of this study were to investigate the results of surgical resection for PHCCA and assess how practice has evolved over the past 15 years.
Methods: A prospectively maintained database was interrogated to identify all resections. Clinicopathological data were...
Objectives: The reference standard technique for the reconstruction of the extrahepatic biliary tree is Roux‐en‐Y hepaticojejunostomy. This procedure is not without complications and may not be feasible in some patients. This project sought to evaluate a novel approach for repairing common bile duct injuries with a biosynthetic graft. This allows for the reconstruction of the anatomy without necessitating...
Background: Microwave ablation (MWA) is increasingly utilized in the treatment of hepatic tumours. Promising single‐centre reports have demonstrated its safety and efficacy, but this modality has not been studied in a prospective, multicentre study.
Methods: Eighteen international centres recorded operative and perioperative data for patients undergoing MWA for tumours of any origin in a voluntary...
Background: Hepatic resection in patients with chronic liver disease (CLD) is associated with a risk of post‐operative liver failure and higher morbidity than patients without liver disease. There is no universal risk stratification scheme for CLD patients undergoing resection.
Objectives: The aim of the present study was to evaluate the association between routine pre‐operative laboratory investigations,...
Background: An extended left hepatectomy is a complex hepatic resection often performed for large tumours in close relationship to major hilar structures. Operative outcomes of this resection for colorectal liver metastases (CLM) remain unclear. The aim of the present study was to assess short‐ and long‐term outcome for patients with CLM after an extended left hepatectomy.
Methods: A retrospective...
Background: A standardized definition of post‐hepatectomy haemorrhage (PHH) has not yet been established.
Methods: An international study group of hepatobiliary surgeons from high‐volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management.
Results: The definition of PHH varies strongly within the...
Background: A new surgical technique to define intra‐operatively segmental and subsegmental areas of the liver using ultrasound‐guided bimanual liver compression has been recently described. However, this technique does not allow disclosure of the subsegmental ventral (S8v) and dorsal (S8d) portions of segment 8 (S8). Another technique that overcomes these limitations is described.
Methods: Six...
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