Liver transplantation for viral hepatitis and hepatic cancer: a minireview

Orthotopic liver transplantation was performed for 43 years. One-year survival rates climbed to as high as 88% and operative mortality rates dropped to as low as zero. Liver resection should still be considered the first-line treatment for patients with hepatocellular carcinoma in non-cirrhotic and resectable livers; however liver transplantation must be the preferred approach for cirrhotic livers. Orthotopic liver transplantation for hepatocellular carcinoma at a more advanced stage was not indicated. Combination therapy with hepatitis B immune globulin and lamivudine for hepatitis B virus patients before and after orthotopic liver transplantation increases survival rates compared to non- hepatitis B virus recipients

Surgical treatment of iatrogenic lesions of the upper biliary tract

To study the outcome of biliary reconstruction in cases of Iatrogenic Bile duct Injury and Structures. Retrospective study conducted from Oct. 1989 to Dec. 2002. Dept. of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, People Republic of China. Ninety four patients who underwent biliary reconstruction. Amongst the 94 patients, 74 injuries resulted from Laparoscopic procedure and 28 from Open Cholecystectomy, while one was the result of Mini Cholecystecomy The patients underwent repair based on Bismuth classification. The outcome was graded as excellent, good and poor. There was no pre-operative death in this series. During the follow-up of 13-15 years, 75 [79.8%] patients had excellent results, 13 [13.8%] good results and 6 [6.4%] poor results. Four patients amongst the poor group died. To reduce the incidence of bile duct injuries it is important to recognize the cystic duct, the common hepatic and the common bile duct junction, and to be familiar with the anatomical variations and the congenital anomalies. The classification of iatrogenic bile duct injuries and strictures, and the timing and technique of biliary reconstruction influence the outcome in these cases

Biliary tract surgery; surgical complications

Surgical complication after biliary tract injury are serious complications of Hepatobiliary surgery. The incidence of iatrogenic bile duct injuries has increased significantly since the number of cholecystectomy operations have increased, laparoscopic cholecystectomy became the "gold standard", mini-cholecystectomy established for the treatment of cholelithiasis. Intraoperative hemorrhage can be life-threatening or may lead the death. The common uses of laparoscopic cholecystectomy and mini-cholecystectomy have made the young surgeons less familiar with open cholecystectomy procedure and the approaches to manage the biliary tract injuries. Uncommonly the patient had to undergo hepatic transplantation secondary to biliary tract surgery with several vessel injuries or biliary cirrhosis. Postoperative bile leakage can be managed by effective drainage as soon as possible. These complications uncommon with the expert surgeons, but common with comparatively inexperienced surgeons. There is no substitute of experience and caution in biliary surgery for optimization technique