scholarly journals Porta Hepatis Injury during Laparoscopic Cholecystectomy

2020 ◽  
Vol 14 (1) ◽  
pp. 234-241
Author(s):  
Reem Shammout ◽  
Raiean Al Habbal ◽  
Fadi Rayya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Treatment Strategy ◽  
Surgical Complication ◽  
Operative Procedure ◽  
Porta Hepatis ◽  
Mortality And Morbidity ◽  
Hepatic Lobe ◽  
The Right ◽  
Vasculobiliary Injury ◽  
The Impact

Iatrogenic porta hepatis injury is a rare but devastating surgical complication of laparoscopic cholecystectomy. There are no systematic studies examining the best treatment strategy in patients with this injury. We present a case of a 23-year-old woman with a large abscess in the right hepatic lobe due to an extreme vasculobiliary injury after laparoscopic cholecystectomy. Although rare, the impact of vasculobiliary injuries after cholecystectomy highlights the need for constant alertness and prompt management in order to minimize mortality and morbidity usually associated with the routine operative procedure.

scholarly journals Is Nighttime Really Not the Right Time for a Laparoscopic Cholecystectomy?

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Anna C. M. Geraedts ◽  
Meindert N. Sosef ◽  
Jan Willem M. Greve ◽  
Mechteld C. de Jong
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Morbidity ◽  
Time Of Day ◽  
Outcome Data ◽  
Emergency Procedure ◽  
Out Of Hours ◽  
Increased Risk ◽  
The Right ◽  
The Impact ◽  
Univariate Analyses

Purpose. The impact of an out-of-hours laparoscopic cholecystectomy on outcome is controversial. We sought to determine the association between an out-of-hours procedure and postoperative complications within 90 days. Methods. Between 2014 and 2016, 1553 laparoscopic cholecystectomies were performed. Therapeutic, operative, and outcome data were prospectively collected and analyzed. We defined out of hours as during weekends, national holidays, and daily between 5PM and 8AM. Results. Most patients operated on were female (n=988; 63.6%) and the majority of procedures were electives (n=1341; 86.3%). Although all procedures were performed with a laparoscopic intent, 42 (2.7%) were converted to open procedure. In total, 145 (9.3%) procedures were out of hours, all nonelective, and in most cases for acute cholecystitis (n=111; 7.1%). Overall, there were 212 complications in 191 patients (12.3%), most (n=153; 9.9%) classified as minor. The conversion rate in the out-of-hours group was significantly higher (9.7% vs 2.0%; p<0.001). While univariate analyses revealed out-of-hours procedure (OR=1.83; p=0.008) to be associated with an increased risk of complications, when controlling for confounding factors by multivariate analysis, this association was not found. However, operation by surgical staff (OR=1.71) and conversion to laparotomy (OR=3.74) were found to be independently associated with an increased risk of complications (both p<0.05), while an emergency procedure tended to be associated with postoperative morbidity (OR=1.82; p=0.069). Conclusion. An out-of-hours laparoscopic cholecystectomy was not found to be an independent risk factor for developing postoperative morbidity and time of day should therefore only be a relative contraindication.

Case 2.37

2014 ◽  
pp. 130-131
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Common Variable Immunodeficiency ◽  
Celiac Axis ◽  
Porta Hepatis ◽  
Axial Diffusion ◽  
Hepatic Lobe ◽  
Diffusion Weighted ◽  
The Right ◽  
Delayed Phase ◽  
Common Variable

50-year-old woman being evaluated for common variable immunodeficiency Coronal SSFSE (Figure 2.37.1), axial fat-suppressed T2-weighted FSE (Figure 2.37.2), and axial diffusion-weighted (b=100 s/mm2) (Figure 2.37.3) images demonstrate a heterogeneous mass with lobulated margins in the right hepatic lobe, as well as extensive adenopathy in the celiac axis, porta hepatis, and portocaval space. Note also moderate splenomegaly. Arterial, portal venous, equilibrium, and delayed phase postgadolinium 3D SPGR images (...

scholarly journals Severe case of post cholecystectomy vasculobiliary injury successfully treated by right hepatectomy with a jump graft to the remaining left hepatic lobe

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Carlo Marino ◽  
Ignacio Obaid ◽  
Gabriela Ochoa ◽  
Nicolás Jarufe ◽  
Jorge A Martínez ◽  
...  
Keyword(s):  
Hepatic Duct ◽  
Open Cholecystectomy ◽  
Severe Case ◽  
Common Hepatic Duct ◽  
Right Hepatectomy ◽  
Left Hepatic Lobe ◽  
Left Hepatic Duct ◽  
Hepatic Lobe ◽  
The Right ◽  
Vasculobiliary Injury

Abstract Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones. She was transferred to our center on postoperative Day 4 because of progressive jaundice and encephalopathy. After a proper investigation, we found an extreme VBI with infarction of the right hepatic lobe associated with complete interruption of the portal vein and proper hepatic artery flows and full section of the common hepatic duct. Right hepatectomy with portal—Rex shunt revascularization of the left hepatic lobe and Roux-en-Y hepaticojejunostomy to the left hepatic duct was done. The patient was discharged on the 60th postoperative day. Discussion: This case shows the successful surgical treatment of a severe cholecystectomy’s VBI, avoiding an emergency liver transplant.

Liver Transplantation for Iatrogenic Porta Hepatis Transection

2009 ◽  
Vol 75 (4) ◽  
pp. 313-316 ◽  
Author(s):  
Victor Zaydfudim ◽  
J. Kelly Wright ◽  
C. Wright Pinson
Keyword(s):  
Liver Transplantation ◽  
Laparoscopic Cholecystectomy ◽  
Surgical Complication ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Porta Hepatis ◽  
Postoperative Course ◽  
United Network

Iatrogenic porta hepatis transection is a rare but devastating surgical complication. There are no systematic studies examining the best treatment strategy in patients with this injury. We report two cases of transection of all three portal structures, one during an open right adrenalectomy and another during a laparoscopic cholecystectomy, both of which were transferred to our tertiary care center hours postinjury. Diagnostic imaging and exploration revealed nonsalvageable livers, and both patients underwent total hepatectomies and portocaval shunting. Donor livers were available 12 to 20 hours after United Network for Organ Sharing Status 1 listing and both patients survived their postoperative course with 2- and 6-year follow up to date. Two-stage total hepatectomy with portocaval shunting followed by liver transplantation should be considered for patients presenting with porta hepatis transection.

Gastroduodenal Artery as the Inflow Tract to Repair the Right Hepatic Artery in a Combined Vasculobiliary Injury after Laparoscopic Cholecystectomy

2007 ◽  
Vol 73 (9) ◽  
pp. 888-889
Author(s):  
Kamran Khanmoradi ◽  
Werviston Defaria ◽  
Ronald E. Moore ◽  
Ralph Guarneri ◽  
Andreas G. Tzakis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Hepatic Artery ◽  
Bile Duct Injury ◽  
Arterial Injury ◽  
Right Hepatic Artery ◽  
Artery Injury ◽  
Hepatic Artery Injury ◽  
The Right ◽  
Vasculobiliary Injury

The frequency and significance of right hepatic artery injury associated with bile duct injury after laparoscopic cholecystectomy is unknown. Many reports suggest that a concomitant arterial injury worsens the outcome and prognosis of the bile duct injury even after an initially successful biliary repair. The optimal management of this complicated injury is controversial. We report a surgical technique to repair the right hepatic artery injury in these cases. We believe this technique is useful for surgeons who opt to repair the arterial injury at the time of biliary reconstruction, especially if it is performed soon after the injury occurred, before permanent damage to the liver and biliary system is established. To the best of our knowledge, this technique was not reported in the literature previously.

scholarly journals Intra-Abdominal Venous Pressure During Laparoscopic Cholecystectomy

HPB Surgery ◽  
1994 ◽  
Vol 8 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Kazuhiro Iwase ◽  
Tetsuto Takao ◽  
Hirotoshi Watanabe ◽  
Yasuhiro Tanaka ◽  
Tetsuo Kido ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Inferior Vena Cava ◽  
Superior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena ◽  
Operative Procedure ◽  
Venous Pressure ◽  
Vena Cava ◽  
Abdominal Pressure ◽  
The Right

Superior vena cava (SVC) and inferior vena cava (IVC) pressures were measured serially during laparoscopic cholecystectomy in which the intra-abdominal pressure was maintained at 12mmHg. The influences of alteration of position from 15 degrees head-down to 15 degrees head-up and of the operative procedure of holding the gallbladder up to the right subphrenic space on SVC and IVC pressures were mild. IVC pressure was maintained almost equal to the intra-abdominal pressure during prolonged continuous pneumoperitoneum lasting longer than 60min, while SVC pressure did not change significantly during operation. The discrepancy between SVC and IVC pressures underwent no change during continuous pneumoperitoneum.

Emotional Reactivity to Visual Content as Revealed by ERP Component Clustering

2015 ◽  
Vol 29 (4) ◽  
pp. 135-146 ◽  
Author(s):  
Miroslaw Wyczesany ◽  
Szczepan J. Grzybowski ◽  
Jan Kaiser
Keyword(s):  
Emotional Reactivity ◽  
Brain Activity ◽  
Affective State ◽  
Occipital Lobe ◽  
Stimulus Onset ◽  
Emotional States ◽  
Neural Basis ◽  
Temporoparietal Junction ◽  
The Right ◽  
The Impact

Abstract. In the study, the neural basis of emotional reactivity was investigated. Reactivity was operationalized as the impact of emotional pictures on the self-reported ongoing affective state. It was used to divide the subjects into high- and low-responders groups. Independent sources of brain activity were identified, localized with the DIPFIT method, and clustered across subjects to analyse the visual evoked potentials to affective pictures. Four of the identified clusters revealed effects of reactivity. The earliest two started about 120 ms from the stimulus onset and were located in the occipital lobe and the right temporoparietal junction. Another two with a latency of 200 ms were found in the orbitofrontal and the right dorsolateral cortices. Additionally, differences in pre-stimulus alpha level over the visual cortex were observed between the groups. The attentional modulation of perceptual processes is proposed as an early source of emotional reactivity, which forms an automatic mechanism of affective control. The role of top-down processes in affective appraisal and, finally, the experience of ongoing emotional states is also discussed.

The Impact of Internal Work Environment on the Retention of Healthcare Providers at Turaif General Hospital

2019 ◽  
Vol 10 (12) ◽  
pp. 1183-1199
Author(s):  
Mohammed Alrouili ◽  
Keyword(s):  
Work Environment ◽  
General Hospital ◽  
Professional Growth ◽  
Healthcare Providers ◽  
Entire Study ◽  
Internal Work ◽  
Research Findings ◽  
Study Population ◽  
The Right ◽  
The Impact

This study attempted to identify the impact of internal work environment on the retention of healthcare providers at Turaif General Hospital in the Kingdom of Saudi Arabia. In particular, the study aimed to identify the dimensions of work circumstances, compensation, and relationship with colleagues, professional growth, and the level of healthcare providers’ retention. In order to achieve the study goals, the researcher used the descriptive analytical approach. The researcher used the questionnaire as the study tool. The study population comprised all the healthcare providers at Turaif General Hospital. Questionnaires were distributed to the entire study sample that consisted of 220 individuals. The number of questionnaires valid for study was 183 questionnaires. The research findings were as follows: the participants’ estimate of the work circumstances dimension was high (3.64), the participants’ estimate of the compensation dimension was moderate (3.32), the participants’ estimate of the relationship with colleagues dimension was high (3.62), the participants’ estimate of the professional growth dimension was weak (2.39), and the participants’ estimate of healthcare providers’ retention level was intermediate (2.75). Accordingly, the researcher’s major recommendations are: the need to create the right atmosphere for personnel in hospitals, the interest of the hospital to provide the appropriate conditions for the staff in terms of the physical and moral aspects for building the work adjustment in the staff, and conducting training courses and educational lectures for personnel in hospitals on how to cope with the work pressures.

The Right to Housing: Challenges Associated with the ‘Waiting List System’ Ekurhuleni Metropolitan Municipality V Various Occupiers, Eden Park Extension 5 2014 3 SA 23 (SCA)

2017 ◽  
Vol 30 (1) ◽  
pp. 112-121
Author(s):  
Shamier Ebrahim
Keyword(s):  
Supreme Court ◽  
Waiting Lists ◽  
The State ◽  
Waiting List ◽  
Allocation Process ◽  
The Supreme Court ◽  
The Right ◽  
The Impact ◽  
Court Of Appeal

The right to adequate housing is a constitutional imperative which is contained in section 26 of the Constitution. The state is tasked with the progressive realisation of this right. The allocation of housing has been plagued with challenges which impact negatively on the allocation process. This note analyses Ekurhuleni Metropolitan Municipality v Various Occupiers, Eden Park Extension 51 which dealt with a situation where one of the main reasons provided by the Supreme Court of Appeal for refusing the eviction order was because the appellants subjected the unlawful occupiers to defective waiting lists and failed to engage with the community regarding the compilation of the lists and the criteria used to identify beneficiaries. This case brings to the fore the importance of a coherent (reasonable) waiting list in eviction proceedings. This note further analyses the impact of the waiting list system in eviction proceedings and makes recommendations regarding what would constitute a coherent (reasonable) waiting list for the purpose of section 26(2) of the Constitution.

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