The safety of the early removal of prophylactic drainage after liver resection based solely on predetermined criteria: a propensity score analysis
|
|
- Tabitha Hoover
- 5 years ago
- Views:
Transcription
1 HPB ORIGINAL ARTICLE The safety of the early removal of prophylactic drainage after liver resection based solely on predetermined criteria: a propensity score analysis Daisuke Hokuto, Takeo Nomi, Satoshi Yasuda, Chihiro Kawaguchi, Takahiro Yoshikawa, Kohei Ishioka, Shinsaku Obara, Takatsugu Yamada & Hiromichi Kanehiro Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, Japan Abstract Background: Prophylactic drainage after liver resection remains a common practice amongst hepatic surgeons. However, there is little information about the optimal timing of drain removal. Methods: From April 2008 to December 2012 (conventional group), the drains were removed based on the treating surgeon s view. From January 2013 to April 2016 (ERP group), the drains were removed on POD 3 if the bile concentration of the drain discharge was less than three times the serum bilirubin on POD 3, and the amount of drain discharge was <500 ml on POD 3. The postoperative outcomes of the two groups were compared using one-to-one propensity score-matching analysis. Results: One hundred nine patients were extracted from ERP group (n = 226) and conventional group (n = 246). The time to drain removal was significantly shorter in the ERP group than in the conventional group (3 days vs. 5 days, P < 0.001). The frequency of delayed bile leakage or the appearance of symptomatic abdominal fluid collection after drain removal did not differ between the two groups (3% vs. 4%, P = 0.791). Conclusion: Drain removal on POD 3 based on the volume and bile concentration is safe. Received 14 October 2016; accepted 3 December 2016 Correspondence Takeo Nomi, Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, Japan. t.nomi45@gmail.com Introduction Traditionally, prophylactic drainage after liver resection has been used to prevent post-operative fluid collection, detect postoperative bile leakage, and/or bleeding. 1 However, due to advances in percutaneous drainage techniques, several authors have suggested that the routine use of prophylactic drainage after liver resection is unnecessary. 2 4 A recent systematic review reported a pooled meta-analysis comparing routine abdominal drainage with no abdominal drainage in elective liver surgery. No difference was observed between the two groups in terms of mortality or the frequencies of intra-abdominal fluid collection that required reoperation or infected intra-abdominal fluid collection. 5 Furthermore, several retrospective cohort studies and randomized controlled trials have suggested that abdominal drainage after liver resection may increase the risk of complications such as wound infection, retrograde abdominal infection, and ascitic fluid leakage. 2,3,6,7 Yet many hepatic surgeons continue to use routine drainage following hepatic resection arguing early detection of bile leakage or hemorrhage and reduced need for re-intervention as reasons to support such an approach. 8,9 However routine drainage has also been associated with asymptomatic drain infection by normal skin flora leading to retrograde infection. 8 The effect of timing of drain removal on the incidence of retrograde infection has not been studied. The aim of this study was to confirm a safety of early drain removal after liver resection using propensity score matching analysis. Methods Study population Data from all consecutive patients who underwent liver resection at Nara Medical University, Nara, Japan from April 2008 to April 2016 were retrieved from a prospective database for this retrospective study. Patients who underwent biliary reconstruction or
2 360 HPB additional resection of other organs were excluded. Prophylactic drainage was performed after liver resection in all patients. Drains were placed near each cut surface of the liver. During the period from April 2008 to December 2012, the drains were removed when the surgeon who performed the liver resection decided to remove them by visual examination of the drain discharge. During the period from January 2013 to April 2016, the drains were removed on POD 3, regardless of the surgeon s view, if the bile concentration of the drain discharge was less than three times the serum bilirubin concentration on POD 3, and the amount of the drain discharge was <500 ml on POD 3. Drains that did not meet these criteria were not removed until the surgeon that performed the liver resection decided to remove them, and drains were used for the treatment of bile leakage or symptomatic abdominal fluid collection if necessary. The perioperative outcomes of the patients who underwent liver resection between January 2013 and April 2016 (ERP group) were compared with those of the patients who underwent the procedure between April 2008 and December 2012 (conventional group). The patients baseline characteristics, the operative procedures and outcomes, postoperative complications, and the length of the postoperative hospital stay were analyzed. Surgical procedures Major hepatectomy was defined as resection of three contiguous segments according to Couinaud s classification. Anatomical resection included segmentectomy, sectionectomy, hemihepatectomy, and tri-sectionectomy. The surgical procedure was performed as described previously. 10 At the end of the resection procedure, white gauze was placed on the cut liver surface for 5 min, and the presence/absence of bile leakage was confirmed. Bile leakage tests involving the injection of dye through the cystic duct were not performed routinely. Fibrin glue was applied to the liver surface after parenchymal transection. A silicon rubber closed drain (SILASCON Duple drain; KANEKA MEDICAL PRODUCTS, Tokyo, Japan) was placed near to each cut liver surface. Intraoperative parameters, including blood loss, blood transfusion use, and the duration of surgery, were recorded. Postoperative outcomes Parameters associated with postoperative liver function (i.e., serum liver transferase and bilirubin levels) were measured on POD 1, 3, 5, and 7. During the period from January 2013 to April 2016, examinations of the bile concentration of the drain discharge were conducted on POD 1 and 3. Abdominal CT was not performed routinely after liver resection. Postoperative complications were stratified according to the Clavien Dindo classification. 11 Major complications were defined as those of grade IIIa or above. Bile leakage was defined according to the definitions of the International Study Group of Liver Surgery (ISGLS). 12 Surgical site infections (SSI) were defined according to the Centers for Disease Control guidelines. 13 Liver failure was diagnosed according to the ISGLS definition. 14 Management of bile leakage and abdominal abscesses Drains that did not meet the abovementioned criteria were not removed. If bile was detected in the drain discharge or a patient developed a fever of >38 C after POD 3, an abdominal CT scan was performed to confirm the existence of intra-abdominal fluid collection due to the insufficient drainage of bile or symptomatic abdominal fluid collection. If fluid collection was observed near the drain, the drain was replaced with a new drain using a guidewire under radiological guidance (the drain salvage technique). If this procedure was considered impossible or the drain had already been removed, percutaneous drainage was carried out under ultrasound guidance. If the amount of bile leakage was >100 ml, endoscopic retrograde biliary drainage or endoscopic retrograde nasobiliary drainage was performed. If these procedures could not be performed or were not effective, surgical drainage was considered. Management of massive ascites In the ERP group, drains through which >500 ml of discharge passed on POD 3 were not removed. Such drains were removed when the amount of discharge reached <500 ml/day or on POD 7. In the conventional group, drains through which >500 ml of discharge were not removed until the surgeon that performed the liver resection decided to remove them. Statistical analyses Continuous data are expressed as medians and ranges. Qualitative variables are expressed as frequencies (percentages). The t- test or the Mann Whitney U test was used for intergroup comparisons of quantitative variables as appropriate, whereas the c 2 test or Fisher s exact test was used to compare categorical data. Two-sided P-values of <0.05 were considered statistically significant. A one-to-one propensity matching by calculating was performed. Propensity scores were calculated for each patient using logistic regression analysis involving the following covariates: the frequency of cirrhosis, the preoperative serum albumin level, the frequency of previous hepatectomy, the frequency of a laparoscopic approach, the duration of the operation, the estimated amount of intraoperative blood loss, and the frequency of blood transfusions. All statistical analyses were performed using SPSS for Windows version 22.0 (SPSS Inc.). Results Preoperative characteristics and surgical outcomes The preoperative characteristics and surgical outcomes of the full analysis set are summarized in Table 1 and the propensity matched set are summarized in Table 2. Using one-to-one propensity matching 109 pairs of patients were matched. There was no significant difference in preoperative characteristics and surgical outcomes between the ERP group and the conventional group in the propensity matched set.
3 HPB 361 Table 1 Baseline patient characteristics ERP group n [ 226 Conventional group n [ 246 P-value Age, median (range) 70 (17 85) 69 (29 84) Gender, male, n (%) 167 (74) 174 (71) Present illness, n (%) Hepatocellular carcinoma 140 (62) 159 (65) Colorectal liver metastases 65 (29) 75 (31) Other 21 (9) 12 (5) Cirrhosis, n (%) 31 (14) 53 (22) Previous chemotherapy, n (%) 41 (18) 45 (18) Preoperative laboratory data, median (range) Total bilirubin, mg/dl 0.7 ( ) 0.7 ( ) Albumin, g/dl 4.3 ( ) 4.2 ( ) ICG-R15, % 12.0 ( ) 11.3 ( ) Tumor size, mm, median (range) 24 (6 300) 27 (7 160) Multiple tumors, n (%) 74 (33) 63 (26) Previous hepatectomy, n (%) 62 (27) 35 (14) <0.001 Major hepatectomy 24 (11) 37 (15) Anatomical resection, n (%) 100 (44) 97 (39) Laparoscopic liver resection 48 (21) 34 (14) Operation time (min) 340 ( ) 239 (74 642) <0.001 Blood loss (g) 386 ( ) 580 ( ) Blood transfusion, n (%) 34 (15) 60 (24) ICG-R15, indocyanine green retention rate at 15 min. Table 2 Baseline patient characteristics after propensity score matching ERP group n [ 109 Conventional group n [ 109 P-value Age, median (range) 68 (17 85) 68 (29 84) Gender, male, n (%) 77 (71) 75 (69) Present illness, n (%) Hepatocellular carcinoma 64 (59) 61 (56) Colorectal liver metastases 32 (29) 43 (39) Other 13 (12) 7 (6) Cirrhosis, n (%) 11 (10) 11 (10) Previous chemotherapy, n (%) 15 (14) 20 (18) Preoperative laboratory data, median (range) Total bilirubin, mg/dl 0.7 ( ) 0.7 ( ) Albumin, g/dl 4.3 ( ) 4.3 ( ) ICG-R15, % 11.6 ( ) 10.7 (2 34.2) Tumor size, mm, median (range) 23 (8 240) 25 (8 160) Multiple tumors, n (%) 30 (28) 27 (25) Previous hepatectomy, n (%) 16 (15) 16 (15) Major hepatectomy 11 (10) 18 (18) Anatomical resection, n (%) 48 (44) 42 (17) Laparoscopic liver resection 21 (19) 21 (19) Operation time (min) 282 ( ) 269 (85 642) Blood loss (g) 404 ( ) 474 ( ) Blood transfusion, n (%) 18 (17) 19 (17) ICG-R15, indocyanine green retention rate at 15 min.
4 362 HPB Postoperative outcomes Post-operative outcomes of the propensity matched patients are shown in Table 3. The time to drain removal was significantly shorter in the ERP group than in the conventional group (3 days vs. 5 days, P < 0.001). The proportions of patients who developed delayed bile leakage or symptomatic abdominal fluid collection after drain removal did not differ between the ERP group and the conventional group (P = 0.791). The postoperative hospital stay of the ERP group was significantly shorter than that of the conventional group (9 days vs. 13 days, P < 0.001). Treatment of bile leakage and symptomatic abdominal fluid collection in the propensity matched analysis are shown in Table 4. The proportion of patients treated with percutaneous drainage did not differ between the two groups. Discussion This study investigated the safety of early drain removal after liver resection. After the introduction of ERP, drains were removed on POD 3, regardless of the surgeon s view, if the bile concentration of the drain discharge was less than three times the serum bilirubin concentration on POD 3, and the amount of drain discharge was <500 ml on POD 3. Before the introduction of ERP, drain removal was mainly decided based on the surgeon s Table 3 Postoperative outcomes ERP group a n [ 109 Conventional group a n [ 109 P-value Time to drain removal, days, median (range) 3 (3 82) 5 (4 81) <0.001 Drain removal on POD 3, n (%) 89 (82) 0 (0) <0.001 Drain removal on POD 4 5, n (%) 4 (4) 72 (66) <0.001 Drain removal on POD 6 7, n (%) 4 (4) 10 (9) Drain removal after POD 8, n (%) 12 (11) 27 (25) Bile leakage (BL) 13 (12) 7 (6) Diagnosed before drain removal 11 (10) 5 (5) Diagnosed after drain removal 2 (2) 2 (2) Symptomatic abdominal fluid collection (SAF) 4 (4) 10 (9) Diagnosed before drain removal 1 (1) 3 (3) Diagnosed after drain removal 3 (2) 7 (6) Mortality, n (%) 0 0 Morbidity, n (%) 33 (30) 35 (32) Major complications (worse than Clavien Dindo grade IIIa) 10 (9) 15 (14) Drain salvage technique for BL or SAF 4 (4) 6(6) Percutaneous drainage for BL or SAF 2 (2) 7 (6) Surgical drainage for BL or SAF 0 0 Other 4 (4) 1 (1) Postoperative bleeding 0 0 Ascites 4 (4) 3 (3) Pleural effusion 2 (2) 3 (2) Pneumonia 2 (2) 1 (1) SSI, n (%) 15 (14) 25 (23) Superficial incisional SSI 3 (3) 9 (8) Deep incisional SSI 0 1 (0) Organ/Space SSI 13 (12) 17 (16) Liver failure, n (%) 8 (7) 10 (9) ISGLS grade A 2 (2) 8 (7) ISGLS grade B 6 (6) 1 (1) ISGLS grade C 0 1 (1) Hospital stay, days, median (range) 9 (5 127) 13 (6 154) <0.001 ISGLS, International Study Group of Liver Surgery; SSI, surgical site infection; POD, postoperative day. a ERP group and conventional group are propensity matched groups.
5 HPB 363 Table 4 Treatment of bile leakage and symptomatic abdominal fluid collection ERP group a Conventional group a P-value Bile leakage, n 13 7 Surgically inserted drains alone, n Drain salvage technique, n Percutaneous drainage, n Reoperation, n 0 0 Symptomatic abdominal fluid, n 4 10 Antibiotics only, n Surgically inserted 0 0 drains alone, n Drain salvage technique, n Percutaneous drainage, n Reoperation, n 0 0 ISGLS, International Study Group of Liver Surgery; SSI, surgical site infection; POD, postoperative day. a ERP group and Conventional group are propensity matched groups. view, and the median time to drain removal was 5 days. To confirm the safety of early drain removal, one-to-one propensity score-matching analysis, in which 109 patients were included in each group, was performed. In the ERP group, the drains were removed on POD 3 in 82% (89/109) of patients, and only 3% (3/ 89) of these patients developed delayed bile leakage or symptomatic abdominal fluid collection, while in the conventional group the drains were removed on POD 4 5 in 66% (72/109) of patients, and 4% of them (3/72) developed delayed bile leakage or symptomatic abdominal fluid collection. Thus, drain removal on POD 3 based on the abovementioned criteria was equally as safe as drain removal based on the surgeon s view. Furthermore, the postoperative hospital stay of the ERP group was significantly shorter than that of the conventional group (9 days vs. 13 days, P < 0.001). These results indicate that early drain removal is safe and feasible in patients that undergo liver resection. There have been a few previous studies about the criteria for drain removal after liver resection. Yamazaki et al. reported a drain fluid bilirubin level of <3 mg/dl on POD 3 as a criterion for drain removal. 15 They found that the drain fluid bilirubin level on POD 3 was the strongest predictor of infection. However, they did not prospectively analyze the validity of this approach. In addition, Tanaka et al. reported the following drain removal criterion: (drainage fluid bilirubin concentration/serum bilirubin concentration) drainage fluid volume (ml) on POD 2 and They prospectively analyzed 50 patients to validate their approach and concluded that it was feasible. These criteria were similar to our use of the drainage fluid bilirubin concentration on POD 3 as a criterion. It was reported that prolonged drain placement after liver resection is associated with drain fluid infections, including retrograde infections. 9,15 In addition, drain insertion cannot be used to treat all patients with bile leakage or symptomatic abdominal fluid collection after liver resection. Indeed, some patients require percutaneous drainage or reoperation, even if prophylactic drains are inserted. This is one of the reasons why prophylactic drains are considered to be unnecessary. 2,3,7 However, in this study 27 of 34 patients with bile leakage or symptomatic abdominal fluid collection were treated without percutaneous or surgical drainage. Thus, prophylactic drainage after liver resection might be useful for patients that exhibit bile leakage or symptomatic abdominal fluid collection. On the other hand, in patients without bile leakage or symptomatic abdominal fluid collection, prolonged prophylactic drainage after liver resection is a risk factor for retrograde infections. So, definitive criteria for the removal of prophylactic drains are needed. The current studies criteria for early drain removal were developed based on two easily assessable factors. In the propensity score-matching analysis set, 20 of 109 (18%) patients did not meet our criteria, and 14 of the 20 patients developed bile leakage or symptomatic abdominal fluid collection, which means that the defined criteria were useful for predicting bile leakage and symptomatic abdominal fluid collection. This study had certain limitations. First, the study was retrospective in nature. Perioperative management of the ERP group and the conventional group were slightly different. For example, mechanical bowel preparation and postoperative insertion of nasogastric tube were omitted in the ERP group. And skin closure was performed by intradermal suture in the ERP group, while by stapler in the conventional group. Nevertheless, one-toone propensity score matching was performed. Second, it was not possible to evaluate the effects of not performing prophylactic drainage after liver resection because drains were routinely inserted after elective liver resection. Despite these limitations, this study provides surgeons with valuable information regarding the optimal timing of drain removal after liver resection. In conclusion, this study demonstrated that it is safe to remove prophylactic drains on POD 3, regardless of the surgeon s view, if the bile concentration of the drain discharge is less than three times the serum bilirubin concentration on POD 3, and the amount of drain discharge is <500 ml on POD 3. Conflicts of interest None declared. References 1. Thompson HH, Tompkins RK, Longmire, WP, Jr.. (1983 Apr) Major hepatic resection. A 25-year experience. Ann Surg 197: PubMed PMID: Pubmed Central PMCID: PMC Epub 1983/04/01. eng. 2. Sun HC, Qin LX, Lu L, Wang L, Ye QH, Ren N et al. (2006 Apr) Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method. Br J Surg 93: PubMed PMID: Epub 2006/02/24. eng. 3. Liu CL, Fan ST, Lo CM, Wong Y, Ng IO, Lam CM et al. (2004 Feb) Abdominal drainage after hepatic resection is contraindicated in
6 364 HPB patients with chronic liver diseases. Ann Surg 239: PubMed PMID: Pubmed Central PMCID: PMC Epub 2004/ 01/28. eng. 4. Burt BM, Brown K, Jarnagin W, DeMatteo R, Blumgart LH, Fong Y. (2002 Nov) An audit of results of a no-drainage practice policy after hepatectomy. Am J Surg 184: PubMed PMID: Epub 2002/11/16. eng. 5. Gurusamy KS, Samraj K, Davidson BR. (2007) Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev, CD PubMed PMID: Epub 2007/07/20. eng. 6. Squires, MH, 3rd, Lad NL, Fisher SB, Kooby DA, Weber SM, Brinkman A et al. (2015 Apr) Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1041 patients. J Am Coll Surg 220: PubMed PMID: Epub 2015/03/01. eng. 7. Ishizawa T, Zuker NB, Conrad C, Lei HJ, Ciacio O, Kokudo N et al. (2014 May) Using a no drain policy in 342 laparoscopic hepatectomies: which factors predict failure? HPB 16: PubMed PMID: Pubmed Central PMCID: PMC Epub 2013/09/03. eng. 8. Kyoden Y, Imamura H, Sano K, Beck Y, Sugawara Y, Kokudo N et al. (2010 Mar) Value of prophylactic abdominal drainage in 1269 consecutive cases of elective liver resection. J hepato-biliary-pancreatic Sci 17: PubMed PMID: Epub 2009/09/04. eng. 9. Tanaka K, Kumamoto T, Nojiri K, Takeda K, Endo I. (2013 Apr) The effectiveness and appropriate management of abdominal drains in patients undergoing elective liver resection: a retrospective analysis and prospective case series. Surg Today 43: PubMed PMID: Epub 2012/07/17. eng. 10. Hokuto D, Nomi T, Yamato I, Yasuda S, Obara S, Yoshikawa T et al. (2016 Dec) The prognosis of liver resection for patients with four or more colorectal liver metastases has not improved in the era of modern chemotherapy. J Surg Oncol 114: PubMed PMID: Epub 2016/09/30. Eng. 11. Dindo D, Demartines N, Clavien PA. (2004 Aug) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240: PubMed PMID: Pubmed Central PMCID: PMC Epub 2004/07/27. eng. 12. Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L et al. (2011 May) Bile leakage after hepatobiliary and pancreatic surgery: adefinition and grading of severity by the International Study Group of Liver Surgery. Surgery 149: PubMed PMID: Epub 2011/02/15. eng. 13. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. (1999 Apr) Guideline for prevention of surgical site infection, Hospital Infection Control Practices Advisory Committee. Infect control Hosp Epidemiol 20: quiz PubMed PMID: Epub 1999/04/29. eng. 14. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R et al. (2011 May) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149: PubMed PMID: Epub 2011/01/18. eng. 15. Yamazaki S, Takayama T, Moriguchi M, Mitsuka Y, Okada S, Midorikawa Y et al. (2012 Nov) Criteria for drain removal following liver resection. Br J Surg 99: PubMed PMID: Epub 2012/10/03. eng.
HEPATECTOMY. Surgical Potpourri Session. ACS NSQIP National Conference Salt Lake City 2012
HEPATECTOMY Surgical Potpourri Session ACS NSQIP National Conference Salt Lake City 2012 Pascal Fuchshuber, MD, PhD, FACS Kaiser Permanente Medical Center Walnut Creek - California Hepatic Resection Is
More informationPreoperative Biliary Drainage Among Patients With Resectable Hepatobiliary Malignancy: Does Technique Matter?
Preoperative Biliary Drainage Among Patients With Resectable Hepatobiliary Malignancy: Does Technique Matter? Q. Lina Hu, MD; Jason B. Liu, MD, MS; Ryan J. Ellis, MD, MS; Jessica Y. Liu, MD, MS; Anthony
More informationPer-Jonas Blind, Bodil Andersson, Bobby Tingstedt, Magnus Bergenfeldt, Roland Andersson, Gert Lindell, Christian Sturesson
2326 LIVER Per-Jonas Blind, Bodil Andersson, Bobby Tingstedt, Magnus Bergenfeldt, Roland Andersson, Gert Lindell, Christian Sturesson Department of Surgery, Clinical Sciences Lund, Skåne University Hospital
More information(Received for Publication: March 24, 2015) Key words portal venous pressure, major hepatectomy, liver
55 Original Article J. St. Marianna Univ. Vol. 6, pp. 55 61, 2015 Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline
More informationUniversity Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
Ann Hepatobiliary Pancreat Surg 2016;20:159-166 https://doi.org/10.14701/ahbps.2016.20.4.159 Original Article Impact of clinically significant portal hypertension on surgical outcomes for hepatocellular
More informationSubtotal cholecystectomy for complicated acute cholecystitis: a multicenter prospective observational study
Study title Subtotal cholecystectomy for complicated acute cholecystitis: a multicenter prospective observational study Primary Investigator: Kazuhide Matsushima, MD Co-Primary investigator: Zachary Warriner,
More informationEarly Outcome of Liver Resections in Octogenarians
Early Outcome of Liver Resections in Octogenarians Bhandari RS, 1 Riddiough G, 2 Muralidharan V, 2 Christophi C 2 ABSTRACT Background 1 Tribhuvan University Teaching Hospital. 2 Austin Health, Royal Melbourne
More informationLiverGroup.org. Case Report Form (CRF) for STAGED procedures
Case Report Form (CRF) for STAGED procedures Patient Characteristics Case number * Age * ( 18)y Gender * Male Female Race * Caucasian Asian African Other If other race, please specify Height * cm Weight
More informationAbandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced Recovery after Surgery Environment
Original Paper Received: April 11, 2016 Accepted: December 5, 2016 Published online: March 25, 2017 Abandoning Prophylactic Abdominal Drainage after Hepatic Surgery: 10 Years of No-Drain Policy in an Enhanced
More informationof bile leakage after liver resecti
NAOSITE: Nagasaki University's Ac Title Author(s) Citation Percutaneous embolization with n-bu of bile leakage after liver resecti Kuroki, Tamotsu; Kitasato, Amane; T Hiroaki; Taniguchi, Ken; Maeda, Shi
More informationCategorizing Wound Infections: A Comparison between ACS-NSQIP and an Institutional Surgical Secondary Events Database
: A Comparison between ACS-NSQIP and an Institutional Surgical Secondary Events Database Luke V. Selby MD, Daniel D. Sjoberg MS, Danielle Cassella MA, Mindy Sovel MPH MS, David R. Jones MD, Vivian E. Strong
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of radiofrequency assisted liver resection Some patient with liver tumours can
More informationPosthepatectomy Liver Failure. C. Jeske
Posthepatectomy Liver Failure C. Jeske Introduction Major source of morbidity and mortality after liver resection Devastating complication Little treatment Incidence: 4-19% Recently < 10% Mortality following
More informationUpdate in abdominal Surgery in cirrhotic patients
Update in abdominal Surgery in cirrhotic patients Safi Dokmak HBP department and liver transplantation Beaujon Hospital, Clichy, France Cairo, 5 April 2016 Cirrhosis Prevalence in France (1%)* Patients
More informationUvA-DARE (Digital Academic Repository) Enhancement of liver regeneration and liver surgery Olthof, P.B. Link to publication
UvA-DARE (Digital Academic Repository) Enhancement of liver regeneration and liver surgery Olthof, P.B. Link to publication Citation for published version (APA): Olthof, P. B. (2017). Enhancement of liver
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: UPPER GI & HPB - HEPATIC, PANCREATIC & BILIARY
More informationSignificance of prophylactic intra-abdominal drain placement after laparoscopic distal gastrectomy for gastric cancer
Hirahara et al. World Journal of Surgical Oncology (2015) 13:181 DOI 10.1186/s12957-015-0591-9 WORLD JOURNAL OF SURGICAL ONCOLOGY RESEARCH Open Access Significance of prophylactic intra-abdominal drain
More informationORIGINAL ARTICLE. Summary. Introduction
JBUON 2017; 22(4): 936-941 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com ORIGINAL ARTICLE A propensity score-matched case-control comparative study of laparoscopic
More informationDisclosures. Dr. Hall is a paid consultant to the American College of Surgeons (ACS) as Associate Director of ACS-NSQIP
Does Routine Drainage of the Operative Bed following Elective Distal Pancreatectomy reduce Complications? An Analysis of the ACS-NSQIP Pancreatectomy Demonstration Project Stephen W. Behrman, MD 1, Ben
More informationSurgical management of HCC. Evangelos Prassas Hepatobiliary and Pancreatic Surgery / Liver Transplantation Kings College Hospital / London
Surgical management of HCC Evangelos Prassas Hepatobiliary and Pancreatic Surgery / Liver Transplantation Kings College Hospital / London Global distribution of HCC and staging systems WEST 1. Italy (Milan,
More informationHenry A. Pitt, M.D., F.A.C.S. Chief Quality Officer Temple University Health System July 23, 2018 Orlando, Florida
Are All OSIs Pancreatic Fistulas? Henry A. Pitt, M.D., F.A.C.S. Chief Quality Officer Temple University Health System July 23, 2018 Orlando, Florida DISCLOSURES Leader, ACS-NSQIP HPB Collaborative Hepatectomy
More informationDO DRAINS HELP OR HURT IN HPB SURGERY? Henry A. Pitt, M.D. Chief Quality Officer Temple University Health System July 23, 2017
DO DRAINS HELP OR HURT IN HPB SURGERY? Henry A. Pitt, M.D. Chief Quality Officer Temple University Health System July 23, 217 DISCLOSURES Henry A. Pitt has nothing to disclose Leader of the ACS-NSQIP HPB
More informationRepeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease
ORIGINAL ARTICLE pissn 2234-778X eissn 2234-5248 J Minim Invasive Surg 2018;21(1):38-42 Journal of Minimally Invasive Surgery Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic
More informationSurgical Management of Advanced Stage Colon Cancer. Nathan Huber, MD 6/11/14
Surgical Management of Advanced Stage Colon Cancer Nathan Huber, MD 6/11/14 Colon Cancer Overview Approximately 50,000 attributable deaths per year Colorectal cancer is the 3 rd most common cause of cancer-related
More informationCitation Transplantation Proceedings, 47(3),
NAOSITE: Nagasaki University's Ac Title Author(s) Hybrid Procedure in Living Donor Li Soyama, Akihiko; Takatsuki, Mitsuhi Tomohiko; Kitasato, Amane; Kinoshit Baimakhanov, Zhassulan; Kuroki, Tam Citation
More informationRevised Annual Program Volumes for ASTS Accreditation Approved May 2013 Revised June 2016
Overview This document outlines new requirements and processes for ASTS accreditation of transplant surgery fellowships including volume requirements for ASTS accreditation, as well as the individual training
More informationSURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION
SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION Facts There were an estimated 157,500 surgical site infections associated with inpatient surgeries in 2011. SSIs were the most common healthcare-associated
More informationOptimal Bile Duct Division Using Real- Time Indocyanine Green Near-Infrared Fluorescence Cholangiography During Laparoscopic Donor Hepatectomy
LETTERS FROM THE FRONTLINE Optimal Bile Duct Division Using Real- Time Indocyanine Green Near-Infrared Fluorescence Cholangiography During Laparoscopic Donor Hepatectomy TO THE EDITOR: Despite advances
More informationEARLY REMOVAL OF THE PROPHYLACTIC DRAIN AFTER DIST AL GASTRECTOMY: RESULTS OF A RANDOMIZED CONTROLLED STUDY
(53) EARLY REMOVAL OF THE PROPHYLACTIC DRAIN AFTER DIST AL GASTRECTOMY: RESULTS OF A RANDOMIZED CONTROLLED STUDY KAZUHIRO MIGIT A, TOMOYOSHI T AKA Y AMA, SOHEI MA TSUMOTO, KOHEI W AKA TSUKI, TETSUYA TANAKA,
More informationManagement of Colorectal Liver Metastases
Management of Colorectal Liver Metastases MM Bernon, JEJ Krige HPB Surgical Unit, Groote Schuur Hospital Department of Surgery, University of Cape Town 50% of patients with colorectal cancer develop liver
More informationComparison Between Primary Closure of Common Bile Duct and T- Tube Drainage After Open Choledocholithiasis: A Hospital Based Study
Original article: Comparison Between Primary Closure of Common Bile Duct and T- Tube Drainage After Open Choledocholithiasis: A Hospital Based Study Kali CharanBansal Principal Specialist (General surgery)
More informationNEW DEFINITION FORMAT AND DIFFICULT VARIABLE DEFINITIONS
NEW DEFINITION FORMAT AND DIFFICULT VARIABLE DEFINITIONS Bruce L. Hall, MD, PhD, MBA, FACS Clinical Support Physician Lead Paula Farrell, RN, BSN ACS NSQIP Clinical Support Specialist Case Studies &
More informationDIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV
DIVERTICULAR DISEASE Dr. Irina Murray Casanova PGY IV Diverticular Disease Colonoscopy Abdpelvic CT Scan Surgical Indications Overall, approximately 20% of patients with diverticulitis require surgical
More informationLaparoscopic Cholecystectomy: A Retrospective Study
Bahrain Medical Bulletin, Vol. 37, No. 3, September 2015 Laparoscopic Cholecystectomy: A Retrospective Study Abdullah Al-Mitwalli, LRCPI, LRCSI* Martin Corbally, MBBCh, BAO, MCh, FRCSI, FRCSEd, FRCS**
More informationSurgical Management of CBD Injury Jin Seok Heo
Surgical Management of CBD Injury Jin Seok Heo Department of Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Bile duct injury (BDI) Introduction Incidence
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: UPPER GI & HPB - HEPATIC, PANCREATIC & BILIARY
More informationComparative Study of Outcomes of Early Versus Interval Laparoscopic Cholecystectomy in Acute Calculus Cholecystitis.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 4 Ver. IX (April. 2017), PP 68-73 www.iosrjournals.org Comparative Study of Outcomes of Early
More informationEvaluation of Complications Occurring in Patients Undergoing Laparoscopic Cholecystectomy: An Institutional Based Study
Original article: Evaluation of Complications Occurring in Patients Undergoing Laparoscopic Cholecystectomy: An Institutional Based Study Sudhir Tyagi 1, Sanjeev Kumar 2* 1 Assistant Professor, 2* Associate
More informationAs a result of recent advances in surgical techniques
SURGICAL INFECTIONS Volume 18, Number 2, 2017 ª Mary Ann Liebert, Inc. DOI: 10.1089/sur.2016.170 Influence of a Shorter Duration of Post-Operative Antibiotic Prophylaxis on Infectious Complications in
More informationMATERIALS AND METHODS Patients
Yonago Acta medica 216;59:232 236 Original Article Usefulness of T-Shaped Gauze for Precise Dissection of Supra-Pancreatic Lymph Nodes and for Reduced Postoperative Pancreatic Fistula in Patients Undergoing
More informationManagement of Cholangiocarcinoma. Roseanna Lee, MD PGY-5 Kings County Hospital
Management of Cholangiocarcinoma Roseanna Lee, MD PGY-5 Kings County Hospital Case Presentation 37 year old male from Yemen presented with 2 week history of epigastric pain, anorexia, jaundice and puritis.
More informationSimone Targa. Impact of an ERAS Colorectal Program on clinical outcomes and costs
Impact of an ERAS Colorectal Program on clinical outcomes and costs Simone Targa U.O. di Clinica Chirurgica Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna ERAS Protocol ENHANCED RECOVERY
More informationLaparoscopic left hepatectomy in patients with intrahepatic duct stones and recurrent pyogenic cholangitis
Korean J Hepatobiliary Pancreat Surg 212;16:15-19 Original Article Laparoscopic left hepatectomy in patients with intrahepatic duct stones and recurrent pyogenic cholangitis Sunjong Han, Insang Song, and
More informationNicolae Bacalbasa Carol Davila University Of Medicine and Pharmacy
Nicolae Bacalbasa Carol Davila University Of Medicine and Pharmacy Approximately 5% to 10% of breast cancers are metastatic at diagnosis (1) 50% of breast cancer patients will develop distant metastases
More informationCitation for published version (APA): Bartels, S. A. L. (2013). Laparoscopic colorectal surgery: beyond the short-term effects
UvA-DARE (Digital Academic Repository) Laparoscopic colorectal surgery: beyond the short-term effects Bartels, S.A.L. Link to publication Citation for published version (APA): Bartels, S. A. L. (2013).
More informationFAST TRACK MANAGEMENT OF PANCREATIC CANCER
FAST TRACK MANAGEMENT OF PANCREATIC CANCER Jawad Ahmad Consultant Hepatobiliary Surgeon University Hospital Coventry and Warwickshire NHS Trust Part 1. Fast Track Surgery for Pancreatic Cancer Part 2.
More informationRisk factors of postoperative ascites on hepatic resection for hepatocellular carcinoma
Ann Hepatobiliary Pancreat Surg 2016;20:153-158 https://doi.org/10.14701/ahbps.2016.20.4.153 Original Article Risk factors of postoperative ascites on hepatic resection for hepatocellular carcinoma Seong
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, pancreatic ductal, laparoscopic distal pancreatectomy for, 61 Adrenal cortical carcinoma, laparoscopic adrenalectomy for, 114
More informationLaparoscopic Liver Resection for Hepatocellular Carcinoma
Original Article Laparoscopic Liver Resection for Hepatocellular Carcinoma Carmen D. Chung, Lydia L. Lau, Kwan Lung Ko, Andrew C. Wong, Shezam Wong, Albert C. Chan, Ronnie T. Poon, Chung Mau Lo and Sheung
More informationLaparoscopic Colorectal Surgery
Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment
More informationMedical Management of Appendicitis: Are We There Yet? Monica E. Lopez, MD, FACS, FAAP
Medical Management of Appendicitis: Are We There Yet? Monica E. Lopez, MD, FACS, FAAP Texas Children s Hospital Objectives Discuss the surgical and non-operative approaches to the treatment of appendicitis
More informationThe Efficacy of NPWT on Primary Closed Incisions
The Efficacy of NPWT on Primary Closed Incisions Pieter Zwanenburg Researcher / PhD Candidate Marja Boermeester Professor of Surgery, Academic Medical Center, Amsterdam Incisional Negative Pressure Wound
More informationDoes Using a Laparoscopic Approach to Cholecystectomy Decrease the Risk of Surgical Site Infection?
ANNALS OF SURGERY Vol. 237, No. 3, 358 362 2003 Lippincott Williams & Wilkins, Inc. Does Using a Laparoscopic Approach to Cholecystectomy Decrease the Risk of Surgical Site Infection? Chesley Richards,
More informationNSQIP-P for the comparative analysis of resource utilization and disease-specific outcomes:
NSQIP-P for the comparative analysis of resource utilization and disease-specific outcomes: Implications for Benchmarking and Collaborative Quality Improvement Shawn J. Rangel, MD, MSCE ACS NSQIP Conference
More informationHOW I DO IT Feasibility of Bisegmentectomy 7 8 is Independent of the Presence of a Large Inferior Right Hepatic Vein
Journal of Surgical Oncology 2006;93:338 342 HOW I DO IT Feasibility of Bisegmentectomy 7 8 is Independent of the Presence of a Large Inferior Right Hepatic Vein MARCEL AUTRAN C. MACHADO, MD, 1,2 * PAULO
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Comparative Study between Laparoscopic and Open Cholecystectomy for Dr. B. Hemasankararao 1,
More informationOutcomes of Patients with Preoperative Weight Loss following Colorectal Surgery
Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery Zhobin Moghadamyeghaneh MD 1, Michael J. Stamos MD 1 1 Department of Surgery, University of California, Irvine Nothing to
More informationUvA-DARE (Digital Academic Repository) Towards safer liver resections Hoekstra, L.T. Link to publication
UvA-DARE (Digital Academic Repository) Towards safer liver resections Hoekstra, L.T. Link to publication Citation for published version (APA): Hoekstra, L. T. (2012). Towards safer liver resections General
More informationDownloaded from jssu.ssu.ac.ir at 13:10 IRST on Saturday October 28th 2017
Journal of Shahid Sadoughi University of Medical Sciences Vol. 21, No. 5, Nov-Dec 2013 Pages: 675-681 1392 5 21 675-681 : 3 2* 1 1392/8/ : -1-2 -3 1391/8/24 : (). :. 1390 200 :.. SPSS (%0/5) 200 (8%) (%9/5)19
More informationCHIRURGIA EPATOBILIARE IN WEEK SURGERY?
U.O.C. di Chirurgia Epatobiliare e dei Trapianti Epatici Università degli Studi di Padova CHIRURGIA EPATOBILIARE IN WEEK SURGERY? Umberto Cillo, MD, PhD, FEBS cillo@unipd.it Quali sono gli ingredienti
More informationSurveillance proposal consultation document
Surveillance proposal consultation document 2018 surveillance of Gallstone disease: diagnosis and management (NICE guideline CG188) Proposed surveillance decision We propose to not update the NICE guideline
More informationValue of E-PASS models for predicting postoperative morbidity and mortality in resection of perihilar cholangiocarcinoma and gallbladder carcinoma
http://dx.doi.org/10.1016/j.hpb.2015.09.001 HPB ORIGINAL ARTICLE Value of E-PASS models for predicting postoperative morbidity and mortality in resection of perihilar cholangiocarcinoma and gallbladder
More informationIs C-reactive Protein an Independent Risk Factor for Complication of Laparoscopic Cholecystectomy for Acute Cholecystitis
Journal of Surgery 2017; 5(3-1): 16-22 http://www.sciencepublishinggroup.com/j/js doi: 10.11648/j.js.s.2017050301.14 ISSN: 2330-0914 (Print); ISSN: 2330-0930 (Online) Is C-reactive Protein an Independent
More informationPrediction of posthepatectomy liver failure using the coefficient variation of relative liver enhancement on hepatobiliary phase images
Prediction of posthepatectomy liver failure using the coefficient variation of relative liver enhancement on hepatobiliary phase images Poster No.: C-0157 Congress: ECR 2015 Type: Scientific Exhibit Authors:
More informationUse of hepatic blood inflow occlusion and hemihepatic artery retention in liver resection for hepatocellular carcinoma
Original Article Use of hepatic blood inflow occlusion and hemihepatic artery retention in liver resection for hepatocellular carcinoma Changjun Jia, Chaoliu Dai, Xingyu Zhao, Xianmin Bu, Feng Xu, Songlin
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,000 116,000 120M Open access books available International authors and editors Downloads Our
More informationProf. Dr. Ahmed ElGeidie Professor of General surgery GEC Dr. Ahmed Abdelrafee
Prof. Dr. Ahmed ElGeidie Professor of General surgery GEC Dr. Ahmed Abdelrafee Diverticulosis of the colon is the presence of pockets in the wall of the colon called diverticula which may, or may not,
More informationPerioperative Management of Hepatic Resection Toward Zero Mortality and Morbidity: Analysis of 793 Consecutive Cases in a Single Institution
ORIGINAL SCIENTIFIC ARTICLES Perioperative Management of Hepatic Resection Toward Zero Mortality and Morbidity: Analysis of 793 Consecutive Cases in a Single Institution Toshiya Kamiyama, MD, Kazuaki Nakanishi,
More informationQuantitative assessment of liver fibrosis using shore durometer
ORIGINAL ARTICLE pissn 2288-6575 eissn 2288-6796 https://doi.org/10.4174/astr.2017.93.6.300 Annals of Surgical Treatment and Research Quantitative assessment of liver fibrosis using shore durometer Young
More informationEn-liang Li 1,2, Rong-fa Yuan 1, Wen-jun Liao 1, Qian Feng 1, Jun Lei 1, Xiang-bao Yin 1, Lin-quan Wu 1* and Jiang-hua Shao 1
Li et al. BMC Surgery (2019) 19:16 https://doi.org/10.1186/s12893-019-0480-1 RESEARCH ARTICLE Open Access Intrahepatic bile exploration lithotomy is a useful adjunctive hepatectomy method for bilateral
More informationInfluencing factors on postoperative hospital stay after laparoscopic cholecystectomy
Korean J Hepatobiliary Pancreat Surg 2016;20:12-16 http://dx.doi.org/10.14701/kjhbps.2016.20.1.12 Original Article Influencing factors on postoperative hospital stay after laparoscopic cholecystectomy
More informationAppendix A: Summary of evidence from surveillance
Appendix A: Summary of evidence from surveillance 2018 surveillance of Gallstone disease: diagnosis and management (2014) NICE guideline CG188 Summary of evidence from surveillance Studies identified in
More informationRadiofrequency Ablation of Liver Tumors
Radiofrequency Ablation of Liver Tumors Michael M. Awad, Michael A. Choti Indications and Contraindications Indications Unresectable malignant tumors of the liver (e.g., hepatocellular carcinoma, colorectal
More informationColorectal Liver Metastases Metachronous
Colorectal Liver Metastases Metachronous Professor Rowan Parks Professor of Surgical Sciences University of Edinburgh No disclosures Natural History of Unresected Untreated Colorectal Metastases Year N
More informationSafety of pancreatic resection in the elderly: a retrospective analysis of 556 patients
ORIGINAL ARTICLE Annals of Gastroenterology (2016) 29, 1-5 Safety of pancreatic resection in the elderly: a retrospective analysis of 556 patients Daniel Ansari, Linus Aronsson, Joakim Fredriksson, Bodil
More informationGeneral summary GENERAL SUMMARY
General summary GENERAL SUMMARY In Chapter 2.1 the long-term results and prognostic factors of radiofrequency ablation (RFA) for unresectable colorectal liver metastases (CRLM) in a single center with
More informationEnhanced Recovery After Discharge: does it happen?
Enhanced Recovery After Discharge: does it happen? Nader K Francis ERAS-UK Southampton 14 th November 2014 BJS 2014 Functional / symptoms Length of hospital stay 37 Readmission 29 Pain 16 Fatigue 9 BJS
More informationTitle. Author(s) Issue Date Right.
NAOSITE: Nagasaki University's Ac Title Author(s) Citation Results of elective laparoscopic ch following percutaneous transhepatic Kuroki, Tamotsu; Kitasato, Amane; T Hiroaki; Taniguchi, Ken; Maeda, Shi
More informationNaoyuki Toyota, Tadahiro Takada, Hodaka Amano, Masahiro Yoshida, Fumihiko Miura, and Keita Wada
J Hepatobiliary Pancreat Surg (2006) 13:80 85 DOI 10.1007/s00534-005-1062-4 Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator s aim
More informationEvolution of Surgery: Role of the Surgeon in the Molecular and Technology Age. Yuman Fong, MD Memorial Sloan-Kettering Cancer Center Rio 2010
Evolution of Surgery: Role of the Surgeon in the Molecular and Technology Age Yuman Fong, MD Memorial Sloan-Kettering Cancer Center Rio 2010 Molecular mechanisms for cancer Prevention and screening Molecular
More informationHow to deal with synchronous primary and liver metastases
How to deal with synchronous primary and liver metastases Luis Sabater Ortí MD, PhD Associate Professor University of Valencia European Board Surgical Qualification HBP (EBSQ-HPB) Department of Surgery.
More informationShort-term outcomes after hepatic resection perspective from a developing country
1242 AUDIT ARTICLE Short-term outcomes after hepatic resection perspective from a developing country Saleema Begum, Muhammad Rizwan Khan Abstract Objective: To review the early outcomes of hepatic resection
More informationNewcastle HPB MDM updated radiology imaging protocol recommendations. Author Dr John Scott. Consultant Radiologist Freeman Hospital
Newcastle HPB MDM updated radiology imaging protocol recommendations Author Dr John Scott. Consultant Radiologist Freeman Hospital This document is intended as a guide to aid radiologists and clinicians
More informationOutcomes associated with robotic approach to pancreatic resections
Short Communication (Management of Foregut Malignancies and Hepatobiliary Tract and Pancreas Malignancies) Outcomes associated with robotic approach to pancreatic resections Caitlin Takahashi 1, Ravi Shridhar
More informationª 2014 by the American College of Surgeons ISSN /13/$
Effect of Preoperative Renal Insufficiency on Postoperative Outcomes after Pancreatic Resection: A Single Institution Experience of 1,061 Consecutive Patients Malcolm H Squires III, MD, MS, Vishes V Mehta,
More informationStudy of the degree of gall bladder wall thickness and its impact on outcomes following laparoscopic cholecystectomy in JSS Hospital
International Surgery Journal Chandra SBJ et al. Int Surg J. 2018 Apr;5(4):1417-1421 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20181122
More informationT-TUBE DRAINAGE VERSUS PRIMARY COMMON BILE DUCT CLOSURE AFTER OPEN CHOLEDOCHOTOMY
T-TUBE DRAINAGE VERSUS PRIMARY COMMON BILE DUCT CLOSURE AFTER OPEN CHOLEDOCHOTOMY Khaled Ahmed El- Dabee, Abd Al-Lateif Ahmed, Mohamed Abdel Aziz Abdel Jawad, Taha Bahgat Salam, Ahmed Eisa Ahmed* and Saed
More informationComplex pancreatico- duodenal injuries. Elmin Steyn Head, Division of Surgery Faculty of Health Sciences Stellenbosch University
Complex pancreatico- duodenal injuries Elmin Steyn Head, Division of Surgery Faculty of Health Sciences Stellenbosch University Pancreatic and duodenal trauma: daunting or simply confusing? 2-4% of abdominal
More informationBile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery
Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery Moritz Koch, MD, a O. James Garden, MD, b Robert Padbury,
More informationLaparoscopic liver resections in surgical treatment of HCC
Laparoscopic liver resections in surgical treatment of HCC Dr Evgeny Solomonov, MD Department of Organ transplantation HPB surgery Unit Beilinson Hospital Petah Tiqva, Israel 0 HCC The sixth most common
More informationReinterventions belong to complications
Reinterventions belong to complications Pancreatic surgery is the archetypus of complex abdominal surgery Mortality (1-4%) and morbidity (7-60%) rates are relevant even at high volume centres Reinterventions
More informationThe effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting.
The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting. { Thalia Petropoulou, Clinical Fellow Paul Hainsworth,Colorectal
More informationCLINICAL LIVER, PANCREAS, AND BILIARY TRACT
GASTROENTEROLOGY 2008;134:1908 1916 BILIARY TRACT Neither Multiple Tumors Nor Portal Hypertension Are Surgical Contraindications for Hepatocellular Carcinoma TAKEAKI ISHIZAWA, KIYOSHI HASEGAWA, TAKU AOKI,
More informationHepatic resection for colorectal liver metastases: prospective study
Key words: Colorectal neoplasms; Hepatectomy; Survival analysis CL Liu ST Fan CM Lo WL Law IOL Ng J Wong Hong Kong Med J 2002;8:329-33 The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road,
More informationLaparoscopic vs Robotic Rectal Cancer Surgery: Making it better!
Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better! Francis Seow- Choen Medical Director Seow-Choen Colorectal Centre Singapore In all situations: We have to use the right tool for the job
More informationNo 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study
Original article Annals of Gastroenterology (2013) 26, 1-6 No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study Rachel M. Gomes
More informationHPB ORIGINAL ARTICLES. Abstract. Correspondence. Introduction
DOI:10.1111/hpb.12207 HPB ORIGINAL ARTICLES Radiofrequency vessel-sealing system versus the clamp-crushing technique in liver transection: results of a prospective randomized study on 100 consecutive patients
More informationAdult Trauma Feeding Access Guideline
Adult Trauma Feeding Access Guideline Background: Enteral feeding access mode (NGT, NDT, PEG, PEG-J, Jejunostomy tube) dependent upon patient characteristics. Enteral feeding management guidelines aim
More informationBile Duct Injury during Lap Chole. Bile Duct Injury during cholecystectomy TOPICS. 1. Prevalence, mechanisms, prevention and diagnosis
Bile Duct Injury during cholecystectomy Catherine HUBERT Jean-Fran François GIGOT Benoît t NAVEZ Division of Hepato-Biliary Biliary-Pancreatic Surgery Department of Abdominal Surgery and Transplantation
More informationComplications in robotic surgery!! Review of the literature! RALP, RAPN and RARC!
Complications in robotic surgery Review of the literature RALP, RAPN and RARC Anna Wallerstedt, MD Karolinska University Hospital Stockholm, Sweden Agenda The importance of reporting surgical complications
More information