Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure

2020 ◽  
Vol 27 (9) ◽  
pp. 614-621
Author(s):  
Shuichiro Uemura ◽  
Ryota Higuchi ◽  
Takehisa Yazawa ◽  
Wataru Izumo ◽  
Takehito Otsubo ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Liver Failure ◽  
Total Bilirubin ◽  
Postoperative Liver Failure ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
The Future

Η αξιολόγηση της κάθαρσης του πράσινου της ινδοκυανίνης (ICG) προεγχειρητικά ως μέθοδος ελέγχου της ηπατικής λειτουργίας μετά ηπατεκτομή

2013 ◽  
Author(s):  
Μιχαήλ Δέρπαπας
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Vena Cava ◽  
Normal Liver ◽  
Postoperative Liver Failure ◽  
Remnant Liver ◽  
Total Blood ◽  
Hepatic Reserve ◽  
Icg Clearance ◽  
Residual Liver Function

Purpose: Liver failure is a major cause of early mortality followinghepatectomy. The future-remnant liver function is an important factor whenassessing the risk for postoperative liver impairment. Several techniques havebeen established for this evaluation, including the ICG test. Aim of the study isto evaluate the ICG clearance in patients scheduled for liver resectionregarding perioperative and postoperative risk factors.Methods: Thirty-one patients, scheduled for liver resection, underwent theICG test. Peri-operative and postoperative variables were recorded andanalyzed using non-parametric tests.Results: Procedures extended from wedge excisions to extendedhepatectomies. Major complications included 1 case of a non-ST elevationmyocardial infarct, 1 case of inferior vena cava thrombosis, 2 cases of liverinsufficiency and 1 case of renal failure. Two patients died due to myocardialinfarction and postoperative liver failure respectively. PDR was foundpositively correlated with total blood loss, transfusion and operation duration.Conclusions: The role of residual liver function and particularly the hepaticreserve assessment on liver surgery may be of most benefit in the routinestratification of risk, enabling surgical procedures to be performed with safety.In this study, the ICG clearance markers were found significantly correlated with perioperative risk factors in histologically „normal‟ liver parenchyma.Interpretation of ICG clearance results may appraise in these patients aninadequate hepatic reserve in the remaining parenchyma postoperatively.Thus, in addition to CT volumetry, functional assessment of the hepaticreserve with ICG may persuade the preoperative planning and preventpostoperative liver failure.

scholarly journals Effect of selective plasmadsorption on systemic inflammatory response and cytokine levels in obstructed jaundice

2021 ◽  
Vol 18 (5) ◽  
pp. 40-46
Author(s):  
А. M. Fomin
Keyword(s):  
Obstructive Jaundice ◽  
Liver Failure ◽  
Total Bilirubin ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Initial Increase ◽  
Tnf Α ◽  
Plasma Cytokines ◽  
Anti Inflammatory ◽  
Α Level

Objective: to study the effect of selective plasmadsorption (SPS) on the level of pro-inflammatory and anti-inflammatory plasma cytokines, markers of liver failure in patients with obstructive jaundice.Material and Methods. The study was conducted in 23 patients with prolonged obstructive jaundice. The baseline level of total bilirubin ranged from 285 μmol/L to 589 μmol/L. All patients were exposed to selective plasmadsorption before biliodigistic surgery and twice in the early postoperative period. Selective plasmosorption was carried using OctoNova by Asahi Kasei Medical (Japan) with the use of the sorbent based on the Plasorba BR-350 anion exchange resin. In one procedure, about two volumes of circulating plasma were treated.Results. Initial increase in the level of pro-inflammatory TNF-α, IL-1β, IL-6 cytokines as well as anti-inflammatory IL-10 cytokine was established.Following SPS, TNF-α level signifcantly decreased by 42.4% (p < 0.05). The decrease in IL-1β and IL-6 was 38.9% and 34.0%, respectively. The level of IL-10 signifcantly decreased by 30.7% (p < 0.05). A signifcant decrease in the levels of total bilirubin by 39.8 ± 3.8%, conjugated bilirubin (by 38.2%), unconjugated bilirubin (by 32.5%), ALT (by 23.5%), AST (by 37%), and bile acids (by 31.4%) was revealed by the end of the procedure. There were no hemorrhagic complications associated with SPS.Conclusions. Selective plasmosorption in complex treatment of patients with mechanical jaundice with hepatic insufciency in perioperative period reduces endotoxicosis level not only due to correction of biochemical markers of liver failure but also due to reduction of proinflammatory and anti-inflammatory cytokines.

scholarly journals Optimization of the future remnant liver: review of the current strategies in Europe

2021 ◽  
Vol 10 (3) ◽  
pp. 350-363
Author(s):  
Riccardo Memeo ◽  
Maria Conticchio ◽  
Emmanuel Deshayes ◽  
Silvio Nadalin ◽  
Astrid Herrero ◽  
...  
Keyword(s):  
Remnant Liver ◽  
Future Remnant Liver ◽  
The Future

scholarly journals Portal vein embolization using an adapted hysterosalpingography catheter

2014 ◽  
Vol 27 (3) ◽  
pp. 204-205 ◽  
Author(s):  
Klaus STEINBRÜCK ◽  
Jefferson ALVES ◽  
Reinaldo FERNANDES ◽  
Marcelo ENNE ◽  
Lúcio Filgueiras PACHECO-MOREIRA
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Colorectal Liver Metastases ◽  
Alcohol Solution ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
Absolute Alcohol ◽  
Portal Branch ◽  
The Future ◽  
Portal Embolization

BACKGROUND: Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. AIM: To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. METHODS: Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam(r) powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. RESULTS: An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. CONCLUSIONS: The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective.

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