Initiation of Liver Transplantation in Bangladesh: Report on the First Two Successful Cases.

Liver transplantation (LT) is the treatment of choice for patients with end-stage liver disease (ESLD). Chronic liver disease due to many causes is prevalent in a significant percentage of the Bangladeshi population. Until recently, liver transplantation facilities were not available, and ESLD patients were dying without treatment. Liver transplantation is a complex procedure that requires integrated and organized approach by a multidisciplinary team. The initiation of liver transplantation in Bangladesh has faced many difficulties. These difficulties have been encountered and overcome in phases. We have successfully performed the first two living-donor liver transplantations (LDLTs) in Bangladesh. The recipient of the first LDLT was a 42-year man with cryptogenic cirrhosis, and the second one was a male of 35 years, suffering from HBV cirrhosis. Both the recipients and donors are doing well and relishing the prospect of a normal life. These two successful liver transplantations are milestones in the development of liver transplantation services in Bangladesh.

Evaluation & management of clinically labeled carcinoma head of the pancreas--a prospective study of 60 patients.

Carcinoma head of the pancreas are assessed by clinical examination, imaging, Endoscopic Retrograde Cholangio Pancreatography (ERCP), Fine Needle Aspiration Cytology (FNAC) and finally by laparotomy. Nevertheless still there is a dilemma in labeling these patients as having inoperable cancer pancreas because operable lesions may be wrongly labeled as inoperable or benign lesion may be thought to be malignant. The aim of this study is to evaluate these patients who present with clinical features of inoperable carcinoma of pancreas and to assess their status of inoperability. Efforts were taken to explore the possibilities of curative resection. If found inoperable, then tissue or cytological sampling of the lesion and the alternative palliation therapy offered to them. Palliative surgery and respective analysis of data was done in 60 patients with clinically labeled carcinoma head of the pancreas. Laparotomy was done for--(i) Assessment of inoperability, (ii) tissue or cytological sampling and (iii) Bilioenteric and gastro enteric bypass. The tumor was considered to be inoperable by peroperative assessment & trial dissection when it invaded the surrounding vital structure. Histological confirmation was made by intraoperative core needle biopsy; shave biopsy, biopsy of hepatic and lymph node metastasis. Cytological sampling was done by transduodenal and intralesional FNAC. Hepaticojejunostomy or Cholecystojejunostomy, Gastrojejunostomy and enteroenterostomy were performed as palliative procedure in all patients. Chemical splanchinectomy was performed in 25 patients. Twenty patients were diagnosed to have carcinoma by Endoscopic biopsy. In remaining 40 patients, peroperative tissue biopsy and cytological sampling yielded pancreatic carcinoma in 16 (40.0%), chronic pancreatitis in 6 (15.0%), pancreatic tuberculosis in 5 (12.5%), pancreatic non Hodgkin's lymphoma in 3 (7.5%) and metastatic pancreatic cancer in 2 (5.0%). However, it failed to reveal any definitive diagnosis in 8 (20.0%) patients. These interesting findings changed the preoperative diagnosis and guided us to plan the surgical procedure for cancerous and non-cancerous patients accordingly.

Necrosectomy followed by closed cavity lavage for necrotising pancreatitis--report of three cases.

Necrotizing Pancreatitis is a life threatening condition involving pancreas, peripancreatic and retroperitoneal tissues. It's serious regional and systemic involvement causes multiple organ or system failure. Planned and carefully performed necresectomy followed by closed cavity lavage can significantly reduce the mortality and morbidity of this catastrophic condition. Meticulous preoperative resuscitation, preparation and operative necrosectomy followed by continuos irrigation in the postoperative period were done in three consecutive patients. The operative procedure including postoperative management and follow up is reported and analyzed.