RESUMEN
Background: the liver is the organ most commonly injured during abdominal trauma. The use of anatomic resection for liver trauma is advocated a conservative surgical approach when operative intervention is required
Objective: to assess the results of anatomic liver resection for severe liver trauma
Patients and Methods: during the period 2003 to 2005, among 100 patients with abdominal trauma and different types of liver injury admitted at El-Minia University Hospital, 20 patients had severe liver injuries and underwent anatomical hepatic resection. All patients had grade IV injury. Pringle maneuver was applied to control hemorrhage. The resections performed included, bi-segmentectomy of segment 6 and segment 7 [n= 8], left lateral segment resection [n = 6], right lobectomy [n = 4] and segmental resection of segment 6 [n= 2]
Results: the mortality rate was 5%, as one patient died postoperatively due to major hepatic vein injury, while the morbidity rate was 25%. Postoperatively, there was a statistically significant improvement in hemodynamic status. One month after surgery, there was statistically non significant minimal change in liver functions
Conclusion: an anatomic resection of the liver for trauma in appropriate situations may be a useful, safe procedure today
RESUMEN
Background: Biliary reconstruction with Roux-en-Y anastomosis remains the treatment of choice for most cases of post-cholecystectomy benign biliary strictures
Aim of study: Prospective evaluation of results and outcome after surgical reconstruction of patients with postcholecystectomy bile duct strictures
Patients and methods: From January 2003, to March 2005, 20 patients had postoperative bile duct strictures after open cholecystectomy, laparoscopic cholecystectomy or common bile duct exploration, underwent biliary reconstruction with Roux-en-Y hepaticojejunostomy or choleducojejunostomy. Preoperative baseline characteristics, postoperative symptomatic grading system of outcome, and postoperative complications were reported over follow-up mean period of 12+/-6.2 months
Results: There was 3 [15%] complications: pancreatitis in one patient [5%], local wound infection in 2 patients [10%]. Mortality was reported in one patient [5%] due to cholangitis. Recurrence of stricture was developed in one patient [5%], who developed cholangitis and died after an interventional radiological trial followed by reoperation, through the follow up period. Regarding the grading system of outcome after surgical connection, as shown in Table 2, most of patients [60%]were in grade I. Grade I and II were excellent results [80%], grade III fair [15%], and grade IV poor [5%]
Conclusion: Surgical reconstruction with Roux-en Y hepaticojejunostomy and transanastomotic stenting or with choleducojejunostomy affords excellent or good results for the vast majority of patients with postocholecystectomy benign biliary strictures
RESUMEN
The duodenal switch [DS] has been found to be a useful operation for treatment of abnormal primary and pathologic duodenogastric reflux. To evaluate the efficacy of the duodenal switch procedure in treatment of abnormal primary and pathologic duodenogastric reflux [DGR]. Over a period of 3 years, 6 patients with symptomatic primary DGR and 14 patients with pathologic DGR following gastrojejunostomy underwent pancreaticobiliary diversion using duodenal switch procedure. Endoscopic evaluation of gastric and duodenal mucosa was done before and after surgery. Symptoms were evaluated with a symptom score using a detailed questionnaire. Suprapapillary duodenojejunostomy [duodenal switch procedure] was done in all patients. During a mean follow-up period of 2 years [range: 0.5-2.8 years], most of the patients had a good satisfactory outcome as defined by endoscopic evaluation and significant reduction in the pre-operative symptoms. There was no reoperation or mortality in our study. The duodenal switch procedure is an effective surgical therapy in patients with primary or pathologic or DGR