What are the most important predictive factors for clinically relevant posthepatectomy liver failure after right hepatectomy for hepatocellular carcinoma?

PURPOSE: The risk of posthepatectomy liver failure (PHLF) after right hepatectomy remains substantial. Additional parameters such as computed tomography volumetry, liver stiffness measurement by FibroScan, indocyanine green retention rate at 15 minutes, and platelet count used to properly assess future liver remnant volume quality and quantity are of the utmost importance. Thus, we compared the usefulness of these modalities for predicting PHLF among patients with hepatocellular carcinoma after right hepatectomy.METHODS: We retrospectively reviewed patients who underwent right hepatectomy for hepatocellular carcinoma between 2007 and 2013. PHLF was determined according to International Study Group of Liver Surgery consensus definition and severity grading. Grades B and C were defined as clinically relevant posthepatectomy liver failure (CRPHLF). The results were internally validated using a cohort of 97 patients.RESULTS: Among the 90 included patients, 15 (16.7%) had CRPHLF. Multivariate analysis confirmed that platelet count < 140 (109/L) (hazard ratio [HR], 24.231; 95% confidence interval [CI], 3.623–161.693; P = 0.001) and remnant liver volume-to-body weight (RVL/BW) ratio < 0.55 (HR, 25.600; 95% CI, 4.185–156.590; P < 0.001) were independent predictors of CRPHLF. Among the 12 patients with a platelet count < 140 (109/L) and RLV/BW ratio < 0.55, 9 (75%) had CRPHLF. Likewise, 5 of 38 (13.2%) with only one risk factor developed CRPHL versus 1 of 40 (2.5%) with no risk factors. These findings were confirmed by the validation cohort.CONCLUSION: RLV/BW ratio and platelet count are more important than the conventional RLV/TFLV, indocyanine green retention rate at 15 minutes, and liver stiffness measurement in the preoperative risk assessment for CRPHLF.

Single Center Experience of Biliary Reconstruction in Living Donor Liver Transplantation: Duct-to-Duct Anastomosis / 대한이식학회지

BACKGROUND: Duct-to-duct anastomosis is the most common biliary reconstruction method in living donor liver transplantation. However, biliary complications can frequently occur. The objective of this study was to examine biliary complications and related risk factors of patients with living donor liver transplantation during the last 12 years in our institution. METHODS: Surgical outcomes of 252 consecutive patients with duct-to-duct anastomosis for biliary reconstruction in living donor liver transplantation between December 2000 and July 2012 were analyzed retrospectively. RESULTS: Among the 252 patients, there were 65 cases (25.8%) of biliary complications. Before 2010, the incidence of biliary complications was 30.4% (56 of 184 cases). After 2011, the incidence was significantly (P<0.05) decreased to 13.2% (nine out of 68 cases). The complication rate of anastomosis of two separated bile ducts of graft to recipient two separated bile ducts using cystic duct and common bile duct of recipient was 50% (10 out of 20), which was relatively higher compared to that of single to single duct anastomosis (47 out of 191, 24.6%) or multiple duct to single duct anastomosis (eight out of 41, 19.5%). CONCLUSIONS: Duct to duct anastomosis between two separated bile ducts of a graft to two separated bile ducts of a recipient, the most common biliary reconstruction method, was associated with higher rate of biliary complications. Complications related to biliary reconstruction of living donor liver transplantation was gradually decreased. Standardization of bile duct anastomosis might lead to sequential reduction of biliary complications in living donor liver transplantations.

Comparison of the Operative Methods for Varicose Veins in the Lower Extremities

PURPOSE: There are several new surgical techniques for varicose vein surgery. Transilluminated Powered Phlebectomy (TIPP) and Endovenous Laser Therapy (EVLT) are accepted as useful surgical procedures for varicose veins. However, these techniques have some associated problems such as complications, remnant varicosities and are relatively expensive. We compared some of the new techniques with conventional methods and introduce new technique called Transillumination assisted EVLT (T-EVLT). METHOD: We reviewed cases with primary varicose veins involving the lower extremity in 217 patients managed by TIPP, EVLT and T-EVLT in the department of Surgery, Presbyterian Medical Center, from January 2003 to January 2007. RESULT: The distribution of age was the fifth decade (38.4%), fourth (23.8%) and third (15.2%), in order frequency. The male to female ratio was 1:1.43. The TIPP procedure had the lowest frequency of remnant varicosities (6.0%) but the second highest complication rate (17.9%). The EVLT procedure had a relatively low complication rate (9.5%) and good cosmetic results but the longest operation time and the highest frequency of remnant varicosities (21.6%). The T-EVLT procedure had the shortest operation time and the lowest frequency of remnant varicosities (19.5%) compared to the EVLT. CONCLUSION: Each of the operation methods had risks and benefits. The EVLT procedure had good cosmetic results and was easy to learn. However, had a relatively long operation time and many remnant varicosities. These problems may be overcome by the T-EVLT.