Liver transection technique in living donor liver transplantation, a comparative study at King Hussien Medical Center- Jordan

Objectives: The aim of this study is to compare clamp crushing technique to Cavitron ultrasonic surgical aspirator for parenchymal transection in terms of efficacy and safety in living donor liver transplantation

Methods: This retrospective study has been conducted to compare Cavitron Ultrasonic Surgical Aspirator and clamp crushing technique. During the period from July 2004 to September 2013, a total of 90 donors underwent liver resection for living donor liver transplantation using clamp crush technique or Cavitron Ultrasonic Surgical Aspirator were included in this study. A total of 90 hepatectomies have been done [77 right hepatectomy¡ 10 left hepatectomy and 3 Left lateral segmentectomy].Data of both groups in term of intraoperative blood loss, need for blood transfusion, transection time, hospital stay, postoperative morbidity and mortality were analyzed.Cavitron Ultrasonic Surgical Aspirator with standard tip was used for parenchymal transection. The primary endpoints were blood loss during parenchymal transection and resection time. Secondary end points were the need for blood transfusion, the degree of postoperative hepatocyte injury, postoperative complication, Intensive care unit stay and hospital stay. The liver resection time defined as the duration from the beginning of parenchymal transection until the completion of transection with complete achievement of hemostasis from the liver cut surface. The remaining liver was assessed daily until hospital discharge, the assessment parameters include: bilirubin level, alanine aminotransferase, aspartate aminotransferase level and Partial thromboplastin time

Results: A total number of 90 patient's records were analyzed in this retrospective study. Clamp crushing technique was used in 48 donors [group A]; while Cavitron ultrasonic surgical aspirator was used in 42 donors [group B]. Mean blood loss was significantly lower in the clamp crushing technique group [310 ml] than the Cavitron ultrasonic surgical aspirator group [345ml] [P value 0.0092]. Transection time was shorter in the clamp crush group but not statically significant. There were no significant differences between both groups in term of postoperative hepatocyte injury indicated by [aspartate aminotransferase and alanine aminotransferase levels], bilirubin and International randomized ratio . There was no significant difference in the Intensive care unit and hospital stay in both groups. No significant difference was found in the postoperative complications between both groups. 7 patient's developed superficial wound infection,4 in group A and 3 in group B. Atelectasis or pleural effusion occur in 11 patients, 6 in group A and 5 in group B. 1 patient in group A developed pneumonia. Biloma occurred in 3 cases, one in group A and 2 in group B. Incisional hernia occurred in 2 patients one in each group. There was no mortality in both groups

Conclusion: Clamp-crush technique has been associated with less blood loss in comparison to Cavitron ultrasonic surgical aspirator. However, there were no significant differences between the two groups regarding morbidity and mortality

Liver transplantation: experience at King Hussein medical center, Jordan

To review the experience and outcome of liver transplantation recipients at King Hussein Medical Center. We retrospectively analyzed the results of 67 liver transplantations; 65 living-related donor liver transplantations for 64 recipients and two cadaveric donor liver transplantation at King Hussein Medical Center between June 2004 and December 2011. The grafts were: 60 right liver lobes, four left liver lobes, one hepatic segments II and III and two whole livers [cadaveric]. All living donors were closely related to the recipients except for the cadavers. Data were obtained by a specially designed medical record abstract form. Of the 67 liver transplantations, the first 42, were performed under the supervision of the Turkish liver transplantation team. Six recipients had concomitant hepatocellular carcinoma and liver cirrhosis. Retransplantation was performed for one recipient. Simple descriptive statistical methods [frequency, mean and percentage] were used to describe the study variables. Total mortality rate was 11 [17%]. The causes of death were sepsis in four patients, hepatic arterial thromboses in three patients, small-for-size in one patient, and porto-pulmonary hypertension in one patient. Morbidity rate was 49 [73.1%]. The main causes of morbidity were biliary leaks in 13 patients, biliary stricture in nine patients, recurrence of primary disease in nine patients acute rejection in five patients, wound infection in four patients, and bile duct stones in one patient. The follow-up period ranged between one month to 90 months [average 45.5 months]. One and three year survival rates were 80% and 70.2% respectively. However, most complications have been treated with interventional techniques. All living donors are alive in a good health and returned to their normal life. In view of critical shortage of cadaveric donor liver transplantation, living-donor liver transplantation is an opportune option for patients with decompensated liver disease in Jordan. Our patients' outcome is improving with time and this could be attributed to gaining more experience and by-passing the learning curve by the liver transplantation team in our center

Adult choledochal Cyst: a case report

Choledochal cyst is an aneurysmal dilatation of the bile duct; it is a rare condition with an incidence between 1:100.000 and 1:150.000 live births in the developed countries, although it is probably more common in the developing countries. We report a case of choledochal cyst in a young 22 year-old female patient. She presented to the out-patient clinic with a history of right upper quadrant abdominal pain. The preoperative diagnosis was made by abdominal ultrasound. The patient made complete recovery after early laparotomy and excision of the cyst. Early suspicion of this rare disease is important because surgical treatment is the only way to avoid its dramatic complications. in this case report we discusse the history, physical examination, investigations, complications and treatment of this rare condition

Appropriateness of admissions to intensive care unit

To improve resource utilization in the intensive care unit by assessing the appropriateness of admissions, exploring the reasons for improper selection of patients for intensive care and recommendations suggested to overcome them. This is a retrospective study conducted at Princess Haya Hospital [a secondary hospital with a total of 120 beds] in Aqaba-Jordan during the period November 1st, 1999 to December 1st, 2001. All medical and surgical adult patients who were admitted to the intensive care unit were involved in the study. The intensive care unit capacity is six beds that open and run mainly by a nursing staff, with no specific intensive care unit policy or protocols. For each admission, patient demographics, diagnosis, cause of admission, length of stay in the intensive care unit and final outcome were collected. Data collected were analyzed for each patient to examine the appropriateness of admission to the intensive care unit according to the criteria for intensive care unit admissions published by the American College of Critical Care Medicine. There were 1169 admissions during the study period where 76% of admissions were medical patients and 53% had acute cardiovascular disorders. Surgical patients constituted 24% of total intensive care unit admissions with 72% of these surgical patients were trauma cases. Only 54.2% of total admissions [medical and surgical patients] were admitted appropriately to intensive care unit. The average length of stay was 2.3 days per patient. Sixty five percent of patients were discharged to hospital wards. About 15% of patients stayed less than 24 hours and a significant ratio 16.6% of admissions discharged home. The mortality rate was 11%. Establishing guidelines for admission, discharge and triage of adult intensive care unit patients is of utmost importance and is supported by the literature. Providing guidelines based on relevant literature and expert opinion will lay down the intensive care unit policy, procedures, and by laws. Subsequently, appropriate utilization of intensive care unit resources will lead to optimizing health care cost

Evaluation of Alvarado score in diagnosis and treatment of acute appendicitis

during recent years different procedures have been used to assist in the diagnosis of questionable cases of acute appendicitis. Among these methods, there are few scoring systems. The aim of this study is to evaluate Alvarado scoring system feasibility, value and accuracy as an aid in surgical decision making in cases of possible appendicitis. a prospective study involving 106 adults and 20 pediatric patients who were referred from emergency department to our surgical unit at princess haya hospital in Aqaba, Jordan with provisional diagnosis of acute appendicitis during the period August, 2001 and January, 2002. scores were determined based on the system described by alvarado. After initial evaluation, the patient either had surgery or observed in the ward. The diagnosis of appendicitis was confirmed histologically in resected specimen. the overall accuracy of Alvarado scoring system for diagnosis of appendicitis in adult male, adult female and children was 93%, 78% and 60% respectively. All patients who had an alvarado score of 9 or higher had appendicitis irrespective of age or gender. For adult male patients who scored 6 to 8, had a probability of having appendicitis equal to 93%. this probability dropped to 47% and 34% in women and children respectively Alvarado scoring system is a simple, safe and effective diagnostic aid in the management of adult male patients with suspected appendicitis while in children and adult female patients other diagnostic aids are needed

Emergency colon surgery: a pilot study

This study was performed to compare the respective outcomes of three different surgical methods in the management of emergency colonic resection and anastomosis: primary repair alone [Group I], primary repair with colostomy [Group II], and primary repair with omental wrapping [Group III]. Methods and Patients: 100 patients with emergency colonic resection were allocated randomly to the three groups according to the type of management. The study was performed during 1992-1996 in three different military hospitals in different regions in Jordan. Two patients were excluded because they did not finally undergo colectomy. Of the 98 patients who matched the criteria of our study, the following results were obtained: anastomosis leak occurred in three patients [two in Group I and one in Group II], there were five prolapsed colostomies [Group II], fourteen patients had wound infection [nine in Group I, three in Group II and two in Group III]. The mean time of hospital stay was 7.0, 7.1, and 6.9 days in the three groups respectively when there were no complications, and when the patients with complications were included, the hospital days were 15.3, 13.5, and 8.3 in the three groups respectively. Total hospital stay and complications were less in loop colostomy than primary repair alone. The fewest complications and the shortest hospital stays tended to be in Group III, primary repair with omental wrapping

Parotid masses: evaluation of diagnostic modalities

This is a retrospective study of 52 cases of parotid swelling at Prince Rashid Ben Al-Hassan Hospital over 2 years period between April 1993 and August 1995, to study the pre and post-operative evaluation of parotid masses. Clinical presentation, computerized tomography, ultrasound and fine needle aspiration cytology were evaluated. Out of 52 cases, 11 patients [21%] had non-neoplastic lesions, 25 [48%] had benign neoplasms and 16 [31%] had malignant neoplasms, of which 9 [17%] were of primary parotid origin, and 7[13%] metastatic lesions. An asymptomatic mass was the most common presentation. We conclude that computerized tomography was found to be more accurate than ultrasound in localization of parotid masses, but both were inaccurate in differentiating benign from malignant lesions