scholarly journals Extended Adhesion-Sparing Liver Eversion during Kasai Portoenterostomy for Infants with Biliary Atresia

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 820
Author(s):  
Filippo Parolini ◽  
Giovanni Boroni ◽  
Pietro Betalli ◽  
Maurizio Cheli ◽  
Domenico Pinelli ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Bowel Perforation ◽  
Demographic Data ◽  
Primary Treatment ◽  
Red Blood Cell Transfusion ◽  
Kasai Portoenterostomy ◽  
Packed Red Blood Cells ◽  
Operative Complications ◽  
Post Operative Complications

Background: Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients. Their true survival rate with the native liver reflects the original KPE and the burden of post-operative complications. We report an original modification of the adhesion-sparing liver eversion (ASLE) technique during KPE that facilitates the total native hepatectomy at time of transplantation. Methods: All consecutive patients with BA who underwent KPE at our department and subsequent LT at Paediatric Liver Transplant Centre at Papa Giovanni XXIII Hospital between 2010–2018 were retrospectively enrolled. All patients underwent ASLE during KPE. Patients’ demographic data, type of KPE, total transplant time (TTT), hepatectomy time (HT), intra-operative packed red blood cells and plasma transfusions, intra- and post-operative complications were noted. Results: 44 patients were enrolled. Median TTT and HT were 337 and 57 min, respectively. The median volume of packed red blood cell transfusion was 95 mL. No patients presented bowel perforation during the procedure or in the short post-operative course. No mortality after LT was recorded. Conclusions: In addition to the well-known advantages of the standard liver eversion technique, ASLE reduces the formation of intra-abdominal adhesions, lowering significantly the risk of bowel perforation and bleeding when liver transplantation is performed for failure of KPE.

scholarly journals Living with biliary atresia: From Kasai portoenterostomy to liver transplantation

2016 ◽  
Vol 45 (2) ◽  
pp. 116
Author(s):  
Naresh P Shanmugam ◽  
Gomathy Narasimhan ◽  
Shaman Rajindrajith
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Kasai Portoenterostomy

scholarly journals Sequential Treatment of Biliary Atresia With Kasai Hepatoportoenterostomy and Liver Transplantation: Benefits, Risks, and Outcome in 393 Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Roberto Tambucci ◽  
Catherine de Magnée ◽  
Margot Szabo ◽  
Aniss Channaoui ◽  
Aurore Pire ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Graft Survival ◽  
Bowel Perforation ◽  
Survival Rates ◽  
Sequential Treatment ◽  
Biliary Cirrhosis ◽  
End Stage ◽  
Sequential Strategy ◽  
Early Reoperation

Introduction: Surgical treatment of biliary atresia (BA) is still based on sequential strategy with Kasai hepatoportoenterostomy (KP) followed by liver transplantation (LT), in case of complicated secondary biliary cirrhosis. Concerns have been expressed regarding the risks of LT related to previous KP, suggesting primary LT as an exclusive treatment of BA.Methods: Single-center retrospective analysis including 393 pediatric patients who underwent LT for BA from 1993 to 2018, categorized into two groups: with (KP) or without (NoKP) previous KP. Pre-LT clinical condition was estimated considering age at LT, time on waiting list, pediatric end-stage liver disease score (PELD), and presence of portal vein hypoplasia. Post-LT outcome was evaluated considering patient and graft survival rates, and need for early reoperation due to abdominal or graft-related complications (<45 days after LT).Results: Two-hundred ninety-six patients (75.3%) were categorized in the KP group, and 97 (24.7%) in the NoKP group. Median age at LT was 1.14 years in the KP group and 0.85 years in the NoKP group (p < 0.0001). PELD score was significantly less severe in KP patients (p < 0.05). One-year patient survival rates were 96.9 and 96.8% in the KP and NoKP groups, respectively (p = 0.43), and the corresponding graft survival was 92.5 and 94.8% (p = 0.97). The need for early reoperation was more frequent in the KP group (29.8%) vs. NoKP group (12.4%, p = 0.01). The rate of bowel perforation was non-significantly higher in the KP group (8.1%) vs. NoKP group (3.1%, p = 0.11).Conclusions: The sequential strategy including KP and LT allowed performing LT in patients with significant older age and better clinical conditions, when compared to those transplanted without previous KP. Patient and graft survivals were not impacted by previous KP. Although previous KP was associated with an increased rate of post-LT surgical complications, bowel perforation and bleeding did not occur significantly more frequently. Such results support the current strategy based on sequential treatment.

scholarly journals Intestinal obstruction in a tertiary care centre in India: are the differences with the Western experience becoming less?

2021 ◽  
Author(s):  
Suvendu Sekhar Jena ◽  
Ravi Chandra Reddy Obili ◽  
Sri Aurobindo Prasad Das ◽  
Ruchir Bhavsar ◽  
Sanket Solanki ◽  
...  
Keyword(s):  
Developing Countries ◽  
Intestinal Obstruction ◽  
Demographic Data ◽  
Tertiary Care ◽  
Developed Countries ◽  
Western World ◽  
Tertiary Care Centre ◽  
Duration Of Symptoms ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background: Patients with intestinal obstruction consist of a major proportion of emergency room visits and the complication is associated with significant morbidity and mortality. It has a diverse etiology and varies from region to country. In developed countries it is mainly due to adhesions and in developing countries due to obstructed hernias. Although there are numerous studies from the western world there have been few recent publications from the developing world. Method: We retrospectively analyzed all the patients admitted for intestinal obstruction to our department from January 1996 to December 2019. Their demographic data, duration of symptoms before presenting to the hospital and duration of stay before surgery in the hospital were noted along with cause and level of obstruction. The type of procedure, any post-operative complications, mortality or re-exploration were also noted. Post-operative complications were graded as per Clavien Dindo classification. Results: A total of 986 patients presented with intestinal obstruction during this period out of which 743 patients underwent surgery. There were 429 (57.74%) males 314 (42.26%) females who had a mean age of 50.1 years (range 11 to 96 years). The commonest cause of obstruction was adhesions in 273 (36.7%) followed by carcinoma [130(17.5%)], tuberculosis [111(14.9%)], stricture [94(12.7%)] and hernia (5.4%) patients. Colorectal surgery was the most common previous procedure in the adhesive group [85(31.1%)]. Colon cancer was the common cause in carcinoma group. Ileum was the most common site of obstruction [329(44.3%)]. The overall operative mortality was 41 (5.5%). Conclusion: Postoperative adhesions are now the commonest cause of intestinal obstruction in our referral center with a comparable mortality rate with western reports. Though the etiology of intestinal obstruction is shifting towards the western pattern, tuberculosis, obstructed inguinal hernia still consists a major chunk of patients in developing countries.

scholarly journals Combined Partial Fistulotomy and Cutting Seton Procedure for Complex Anal Fistula

2020 ◽  
Vol 7 (1) ◽  
pp. 40-43
Author(s):  
Md Mamunur Rahman ◽  
Nelema Jahan ◽  
Md Saiful Islam ◽  
Md Selim Sarker ◽  
Suman Chandra Roy ◽  
...  
Keyword(s):  
Demographic Data ◽  
Study Data ◽  
Data Types ◽  
Early Recovery ◽  
Fistula In Ano ◽  
Data Collection Sheet ◽  
Operative Complications ◽  
Complex Fistula ◽  
Cutting Seton ◽  
Post Operative Complications

Background: Fistula in ano of complex variety has been a common surgical problem. Varieties of surgical procedures are encountered for management of this disease but recurrence is a notorious complication of this disease. Objective: The purpose of the present study was to assess outcomes of complex fistula in ano after fistulotomy with seton procedure. Methodology: This prospective study was performed in Dhaka Dental College, Dhaka, Bangladesh from January 2017 to December 2018 for a period of two years. Patients were included in this study. Data collected in data collection sheet regarding demographic data, types of operative procedures, post-operative complications and outcome of patients which were then analyzed. Result: Total 31 patients were included in this study. Age ranged from 20 to 60 years. Male was 28(90.32%) cases and female was in 3(9.68%) cases. High trans-sphincteric fistula were 28(90.32%) cases, extra-sphincteric fistula were 3(9.68%) cases. Fistulotomy with cutting seton by rubber bands were 12(38.71%) cases, fistulotomy with cutting seton by silk 19(61.29%) cases. Seton fell on its own 16(51.61%) cases, not fell 15(48.39%). Post-operative complications were incontinence of gas 5(16.13%) cases, incontinence of stool 1(3.23%) cases, recurrence 1(3.23%) cases. Conclusion: Outcomes of fistulotomy with cutting seton were satisfactory in most patients. Early recovery, low complication rate were encountered in treatment of complex fistula in ano by partial fistulotomy with cutting seton procedure. Journal of Current and Advance Medical Research 2020;7(1): 40-43

scholarly journals LDLT Portal Vein Thrombosis: Technical Advances

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M B Ahmed ◽  
M A Rady ◽  
M A Abd-errazik ◽  
A R M A Azzam
Keyword(s):  
Liver Transplantation ◽  
Blood Loss ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Operative Time ◽  
Surgical Techniques ◽  
Vein Thrombosis ◽  
Operative Complications ◽  
End Stage ◽  
Post Operative Complications

Abstract Background portal vein thrombosis (PVT) is a common complication of end-stage liver disease with an incidence of 0.6–16% in patients with well-compensated disease (1–3), increasing up to 35% in cirrhotic patients with hepatocellular carcinoma. Aim of the Work the aim of the study is to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis, and post-operative complications. Patients and Methods This is a retrospective cohort study to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis & post-operative complications. The study was conducted as retrospective study of 33 adult patients who underwent LDLT at Ain Shams Specialized Hospital, Ain Shams University, Cairo, Egypt, between January 2016 and July 2018. Results the mean child score was 9.55 and the median hospital stay was 12 days. Based on review manager statics program, the PVT recurrence was non-significant (P = 0.295, Test value: 1.096). However, the blood loss was significant (p < 0.029, test value: -2.186) and the surgical time was significant (p = 0.013, test value: 2.633). Conclusion portal vein thrombosis (PVT) represents a significant technical challenge in liver transplantation and for many years was considered a relative contraindication. While advances in surgical techniques, axial imaging, and alternative inflow reconstruction options have made liver transplantation possible in transplant candidates with PVT.

Variceal Bleeds in Patients with Biliary Atresia

2017 ◽  
Vol 28 (05) ◽  
pp. 439-444 ◽  
Author(s):  
Mauri Witt ◽  
Niels Bax ◽  
Henkjan Verkade ◽  
René Scheenstra ◽  
Ruben de Kleine ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Biliary Atresia ◽  
Variceal Bleeding ◽  
Laboratory Tests ◽  
Subsequent Development ◽  
Kasai Portoenterostomy ◽  
Receive Treatment ◽  
Related Mortality

Introduction Portal hypertension often occurs in biliary atresia (BA). The subsequent development of esophageal varices and bleeding from these varices are a well-known complication. We aim to describe the incidence and severity of variceal bleeding in patients with BA. In addition, we describe the characteristics of patients who experienced variceal bleeds. Materials and Methods We included all infants treated for BA at our center between March 1987 and August 2015. Variceal bleeding was defined as hematemesis and/or melena with presence of varices at endoscopy. Findings at endoscopy and ultrasound, laboratory tests, clearance of jaundice, fibrosis-grade at Kasai portoenterostomy, and several varices prediction scores were documented. Routine endoscopies were not performed. Results In this study, 74 patients were included. During follow-up, 18 out of 74 patients (24%) developed variceal bleeding at an age of 9 months (range, 4–111). Twelve patients were listed for liver transplantation at the time of bleeding. Patients who did not clear their jaundice developed variceal bleeds more often and earlier in life. Bleeds were treated with sclerotherapy, banding, or octreotide. Four patients did not receive treatment. No bleeding-related mortality occurred. Conclusion One-fourth of the children diagnosed with BA experience variceal bleeds during follow-up. Most of these children are younger than 1 year and often already listed for transplantation. Major complications did not occur after variceal bleeding.

scholarly journals 579. Prophylactic Antibiotics Did Not Decrease Recurrent Cholangitis in Patients with Biliary Atresia After Kasai Portoenterostomy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S354-S355
Author(s):  
Thomas M Tarro ◽  
Laurie Song ◽  
Beth A Carter ◽  
Meiyu Yeh ◽  
Pia S Pannaraj ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Antibiotic Prophylaxis ◽  
Biliary Atresia ◽  
Panel Member ◽  
Prophylactic Antibiotics ◽  
Resistant Bacteria ◽  
Kasai Portoenterostomy ◽  
Research Support ◽  
Prophylaxis Group ◽  
Culture Positive

Abstract Background Biliary atresia (BA) is a rare, progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree seen in children. The current standard treatment is surgical management with Kasai portoenterostomy (KP). Bacterial cholangitis is a frequent complication following KP and an important determinant of long-term prognosis. Use of prophylactic antibiotics is common but not universal and efficacy is controversial. Methods A retrospective study was performed that included all patients with BA who underwent KP from November 2002 to July 2019. Chart review was conducted to collect demographic information and evaluate the use of antibiotic prophylaxis, number of cholangitis episodes, time to liver transplantation (LVT), and survival. Results Ninety-one patients with BA underwent KP during the study period. Seventy-two (79%) received prophylactic antibiotics, and 19 (21%) did not. The median duration of prophylactic antibiotics was 7 months (interquartile range [IQR] 8.5). Patients in the no-prophylaxis group had significantly fewer cholangitis episodes (median 0, IQR 1) than in the antibiotic prophylaxis group (median 1, IQR 2), p= 0.0201. The median time to LVT was 8 months (IQR 8.5) in the antibiotic prophylaxis group, compared to 7 months (IQR 6) in the no-prophylaxis group, p=0.8827. Of the patients who were on antibiotic prophylaxis, 57 (79.2%) received trimethoprim-sulfamethoxazole (TMP-SMX) alone and 15 (20.8%) received multiple/other antibiotics. Seven patients (7.7%) had culture-positive cholangitis. Six of 7 received prophylaxis with TMP-SMX and 5 of 7 grew bacteria that were resistant to TMP-SMX. No deaths occurred between the postoperative KP period to the time of LVT in both groups. Table 1. Characteristics of Patients in the Prophylaxis and No-prophylaxis Groups. Table 2. Impact of Prophylactic Antibiotics in the Period Between Kasai Portoenterostomy and Liver Transplantation. Table 3. Patients with Culture-positive Cholangitis after Kasai Portoenterostomy (n=7). Conclusion Antibiotic prophylaxis was frequently used after KP with TMP-SMX being the most common antibiotic used. Patients in the no-prophylaxis group had significantly fewer cholangitis episodes compared to those receiving antibiotic prophylaxis. Prophylactic antibiotics did not have an impact on time to LVT. Our findings suggest that antibiotic prophylaxis is not helpful in decreasing the frequency of cholangitis episodes after KP and may increase the risk for infections with resistant bacteria. Larger prospective randomized control studies are recommended. Disclosures Pia S. Pannaraj, MD, MPH, AstraZeneca (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member)

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