Unfavorable effect of high postoperative fluid balance on outcome of pancreaticoduodenectomy

Purpose@#Despite the many efforts to overcome postoperative complications, pancreaticoduodenectomy (PD) is still accompanied with considerable concerns of lethal complications. The clinical factors are known to affect postoperative outcomes such as diameter of pancreatic duct, texture of pancreas, and comorbidity of the patients are mostly uncorrectable. Thus, investigation for correctable risk factors is required. Recently, perioperative fluid volume was reported to be associated with complications after PD. This study aims to determine the relationship between postoperative fluid balance and surgical outcome after open PD. @*Methods@#We reviewed, retrospectively, 172 consecutive patients who underwent open PD in a single institution between 2015 and 2019. The status of perioperative fluid balance 2 days after surgery and clinical factors were investigated to determine the association with postoperative outcome including postoperative pancreatic fistula (POPF). According to postoperative fluid balance, patients were divided into high- and low-balance groups, and clinical features and surgical outcomes were compared between both groups. Multivariate analysis were performed to identify risk factors for POPF. @*Results@#The percentage of morbidity and the incidence of POPF were higher in the high-balance group compared to the low-balance group (61.6% vs. 37.2%, P = 0.001; 15.1% vs. 3.5%, P = 0.009). High postoperative fluid balance and the presence cardiovascular disease were correlated with POPF on multivariate analysis (odds ratio [OR], 4.574; 95% confidence interval [CI], 1.229–17.029; P = 0.023 and OR, 3.517; 95% CI, 1.209–12.017; P = 0.045). @*Conclusion@#Higher amount of postoperative fluid balance and the presence of cardiovascular disease are associated with POPF after PD.

Various types of reconstruction after pancreaticoduodenectomy for the patients who underwent all types of gastrectomy: a single-center experience

Purpose@#The incidence of patients requiring pancreaticoduodenectomy (PD) following any type of gastrectomy is increasing as the population of elderly patients is increasing, especially in endemic areas of gastric cancer such as Korea. All types of gastrectomy can be categorized as subtotal gastrectomy with Billroth I (BI), Billroth II (BII), and total gastrectomy with Roux-en-Y anastomosis. In this paper, we reviewed our experiences of PD for patients who previously underwent gastrectomy. @*Methods@#We reviewed the medical records of the patients who underwent PD following any type of gastrectomy among 505 consecutive patients who underwent PD in a single institution between 2011 and 2020 retrospectively. @*Results@#There were 13 patients who had undergone gastrectomy including 7 patients of BI, 1 patient of BII, and 5 patients of total gastrectomy. For all 7 patients of BI, the reconstruction was not different from conventional PD. For the 1 patient of BII, previous gastrojejunal anastomosis was preserved and reconstruction was performed in Roux-en-Y method. For the 5 patients with total gastrectomy, 2 different types of reconstruction were performed. In one patient, we removed the remaining jejunum with the specimen, and reconstruction was performed. For the other 4 patients, the remaining jejunum, distal to the Treitz ligament, was preserved and was utilized for anastomosis. Surgeries for all patients were uneventful. @*Conclusion@#PD following any type of gastrectomy can be safe. Especially, if the length of remained jejunum is long enough, its utilization for the reconstruction can be an appropriate option.

Effect of end-to-side inverted mattress pancreaticojejunostomy following central pancreatectomy on the prevention of pancreatic fistula

PURPOSE: Central pancreatectomy (CP) may be indicated for the treatment of benign or low-grade malignant tumor in the neck and proximal body of the pancreas. Pancreatic fistula is one of the most common complications after CP. In this study, we suggested an inverted mattress pancreaticojejunostomy (IM-PJ) technique to decrease the risk of pancreatic fistula. METHODS: Between 2010 and 2015, CP was performed with IM-PJ for 10 consecutive patients with a benign or low-grade malignant tumor in the neck and proximal body of the pancreas. All clinical and pathological data were analyzed retrospectively. RESULTS: Median age was 56.4 years (range, 17–75 years). Median surgery duration was 286 minutes (range, 205–410 minutes). In all cases, the distal stump was reconstructed using the IM-PJ method. Median duration of hospital stay was 23.8 days (range, 9–53 days). No patient mortality occurred. Pancreatic fistula developed in 9 cases (90%); however, all fistulas were grade A and resolved without surgical or radiological intervention. Nine patients remain well with no recurrence or new endocrine or exocrine dysfunction. CONCLUSION: Our results demonstrate that the outcomes of CP with IM-PJ are reasonable for prevention of pancreatic fistula following CP.

Outcomes and recurrence pattern after non-anatomic liver resection for solitary hepatocellular carcinomas

BACKGROUNDS/AIMS: Anatomic resection (AR) is preferred for eradicating portal tributaries in patients with hepatocellular carcinoma (HCC). However, the extent of resection is influenced by underlying liver disease and tumor location. We compared the surgical outcomes and recurrence pattern between non-anatomic resection (NR) and AR. METHODS: From March 2009 to February 2012, 184 patients underwent surgical resection for HCC. Among these, 79 patients who were primarily treated for a single tumor without rupture or macroscopic vascular invasion were enrolled. The patients were divided into 2 groups based on the extent of resection: AR (n=31) or NR (n=48). We compared the clinical characteristics, overall survival, disease-free survival, pattern of recurrence, and biochemical liver functions during the perioperative period between the two groups. RESULTS: The extent of resection had no significant effect on overall or disease-free survival rates. The overall 1- and 3-year survival rates were 97% and 82% in the AR group, and 96% and 89% in the NR group, respectively (p=0.49). In addition, the respective 1- and 3-year disease-free survival rates for the AR and NR groups were 84% and 63%, and 85% and 65%, respectively (p=0.94). On the other hand, the presence of hepatic cirrhosis and a tumor size of >5 cm were significant risk factors for recurrence according to multivariate analysis (p<0.001 and p=0.003, respectively). The frequency of early recurrence, the first site of recurrence, and the pattern of intrahepatic recurrence were similar between the 2 groups (p=0.419, p=0.210, and p=0.734, respectively); in addition, the frequency of marginal recurrence did not differ between the 2 groups (1 patient in the AR group and 2 in the NR group). The NR group showed better postoperative liver function than the AR group. CONCLUSIONS: Non-anatomic liver resection can be a safe and efficient treatment for patients with a solitary HCC without rupture or gross vascular invasion.

Late Hepatic Venous Outflow Obstruction Following Inferior Vena Cava Stenting in Patient with Deceased Donor Liver Transplantation Using Modified Piggyback Technique / 대한이식학회지

Following liver transplantation, a few reports have documented hepatic venous outflow obstruction (HVOO) after inferior vena cava (IVC) stenting for the treatment of IVC stenosis. However, HVOO occurred early after IVC stenting and was mostly associated with living donor liver transplantation. Here, we report a case of HVOO that occurred 31 months after IVC stenting in a man who received deceased donor liver transplantation (DDLT) using a modified piggyback (PB) technique. The cause of HVOO was unclear, but one possible explanation is that the balloon-expandable IVC stent might have compressed the IVC chamber on the donor liver side, which would have changed the outflow hemodynamics, resulting in intimal hyperplasia. Therefore, simultaneous hepatic venous stenting with IVC stent placement could help prevent HVOO in patients receiving DDLT with the modified PB technique.

Distal pancreatectomy with celiac axis resection for pancreatic body and tail cancer invading celiac axis

PURPOSE: Pancreatic body/tail cancer often involves the celiac axis (CA) and it is regarded as an unresectable disease. To treat the disease, we employed distal pancreatectomy with en bloc celiac axis resection (DP-CAR) and reviewed our experiences. METHODS: We performed DP-CAR for seven patients with pancreatic body/tail cancer involving the CA. The indications of DP-CAR initially included tumors with definite invasion of CA and were later expanded to include borderline resectable disease. To determine the efficacy of DP-CAR, the clinico-pathological data of patients who underwent DP-CAR were compared to both distal pancreatectomy (DP) group and no resection (NR) group. RESULTS: The R0 resection rate was 71.4% and was not statistically different compared to DP group. The operative time (P = 0.018) and length of hospital stay (P = 0.022) were significantly longer in DP-CAR group but no significant difference was found in incidence of the postoperative pancreatic fistula compared to DP group. In DP-CAR group, focal hepatic infarction and transient hepatopathy occurred in 1 patient and 3 patients, respectively. No mortality occurred in DP-CAR group. The median survival time (MST) was not statistically different compared to DP group. However, the MST of DP-CAR group was significantly longer than that of NR group (P < 0.001). CONCLUSION: In our experience, DP-CAR was safe and offered high R0 resection rate for patients with pancreatic body/tail cancer with involvement of CA. The effect on survival of DP-CAR is comparable to DP and better than that of NR. However, the benefits need to be verified by further studies in the future.

The effects of the end-to-side inverted mattress pancreaticojejunostomy on postoperative pancreatic fistula: a single surgeon's experience

PURPOSE: Various pancreaticojejunostomy (PJ) techniques have been devised to minimize the rate of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study describes a modification of the mattress suture PJ technique, which we call "inverted mattress PJ (IM)". The results of an IM group and a historical consecutive control group were compared to determine how the IM technique affected POPF. METHODS: From 2003 to 2010, 186 consecutive patients underwent PD. A former group of 52 consecutive patients who underwent conventional duct-to-mucosa PJ (DM) was used as a historical control group. The IM technique was utilized for the IM group (134 patients). The clinicopathological features and surgical outcomes of the 2 groups were compared, with a particular focus on postoperative POPFs. RESULTS: The average surgery duration was shorter in the IM group (580.3 minutes vs. 471 minutes, P < 0.001). Grades B and C POPFs occurred less frequently in the IM group, but the difference was not statistically significant (17.3% vs. 9.7%, P = 0.200). However, no grade C POPF occurred in the IM group compared with 5.8% of grade C POPFs (3/52) in the DM group (P = 0.020). Three patients died (1 in the DM group and 2 in the IM group). The causes of death were arrhythmia in 2 cases and Candida sepsis in 1 case. POPF was not causally related to the 3 deaths. CONCLUSION: IM end-to-side PJ shortened operation time and increased safety with no incidence of grade C POPF.

A rare case of gallbladder torsion along the axis of body: a case report

Abnormal attachment of the gallbladder to the liver is the main cause for gallbladder torsion. However, the present study reports a rare case of gallbladder torsion in which a portion of fundus is rotated along the axis of body. So far, very few similar cases have been reported. An 87-year-old woman complaining right upper quadrant abdominal pain for 4 days was admitted. Her body temperature was 38.5degrees C with moderate dehydration. A large tender mass was palpated on the right abdomen extending to the right iliac fossa. Computed tomography of abdomen showed a large cavity with a diameter of 15 cm containing a big stone and a small normal looking gallbladder. Ultrasonographic scan showed a twisted portion of the gallbladder torsion. During emergency laparotomy, the middle portion of the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal. The proximal body of the gallbladder was spared and attached firmly to the liver. Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complications. Histological findings of specimen were consistent with operative findings. The current study reports on a rare case of gallbladder torsion by reviewing previous studies.

Deceased donor liver transplantation performed one week after small bowel resection for complicated umbilical hernia: a case report

Emergent abdominal surgery in cirrhotic patients with ascites can result in dismal postoperative outcomes such as sepsis and hepatic failure. In the present case, small bowel resection followed by anastomosis by the hand-sewn method was performed for small bowel strangulation caused by an umbilical hernia; deceased donor liver transplantation was performed one week after the bowel resection because of deterioration of hepatic function. To the best of our knowledge, this is the first case of liver transplantation performed at only one week after small bowel resection; and although we obtained a good result, the optimal time to perform liver transplantation in this situation requires further evaluation.

Solid pseudopapillary tumor of the pancreas in children: 15-year experience at a single institution with assays using an immunohistochemical panel

PURPOSE: The aim of this study was to analyze the clinicopathological characteristics of solid pseudopapillary tumor (SPT) of the pancreas and to utilize an immunohistochemical panel to identify specific markers of the disease. METHODS: Eleven patients diagnosed with and treated for SPT of the pancreas over the past 15 years were retrospectively analyzed. RESULTS: The 11 patients consisted of 8 females and 3 males, of mean age at operation of 13.5 years (range, 10 to 18 years). The most frequent presenting symptom was abdominal pain and/or mass. One patient was referred with hemoperitoneum due to traumatic tumor rupture. The lesions were located in the body, head and tail of the pancreas in four, four, and three patients, respectively. Mean tumor diameter was 7.9 cm (range, 2.5 to 15 cm). Surgical procedures included distal pancreatectomy with splenectomy in four patients, pylorus preserving pancreaticoduodenectomy in four, distal pancreatectomy in two, and subtotal pancreatectomy with splenectomy in one. Mean follow-up was 60.5 months (range, 15 to 126 months). All patients remain alive without tumor recurrence. Immunohistochemical staining showed that all tumors were positive for beta-catenin, progesterone receptor (PR), vimentin, and CD99. However, all tumors were negative for E-cadherin and cytokeratin 7 expression. CONCLUSION: Patients with SPT of the pancreas have an excellent prognosis after surgical excision. Immunohistochemically, E-cadherin/beta-catenin, PR, vimentin, and CD99 would help establish the diagnosis of SPT of the pancreas, although the results of immunohistochemical staining were found to have an indistinct complex immunoprofile.

Signet-Ring Cell Carcinoma of the Distal Common Bile Duct: Report of a Case

No abstract available.

Surgical treatment for advanced pancreatic cancer

The role of multimodality therapy and surgery for the treatment of locally advanced pancreatic cancer remains to be determined. Although no randomized trials have been done to determine the optimal management of this difficult clinical problem, numerous series reporting successful surgical resection with negative (R0) or microscopic margin (R1) showing favorable long-term survival provide a basis for an aggressive approach in selected cases of advanced cancer of the pancreas. In the absence of conclusive clinical trials, neoadjuvant treatment followed by surgical resection seems to be the optimal approach for locally advanced pancreatic cancers when the potential for surgical resection is suggested by preoperative high quality CT imaging. In particular, when the tumor is within the criteria for borderline resectable pancreatic cancer, efforts to achieve R0 resection are warranted. For those selected cases invading the hepatic artery and superior mesenteric artery, combined arterial resection and reconstruction may be performed to achieve R0 resection. Nonetheless, such a complex procedure should be balanced by a high rate of postoperative complications. In contrast, in cases of tumors invading the celiac axis, R0 resection by combined celiac axis resection can be performed without a high rate of postoperative complications. Survival benefit needs to be verified by further studies in the future.

Clinical Analysis of Traumatic Pancreatic Injury

PURPOSE: Althoughpancreas injury is rare in abdominal trauma,it posesa challengeto the surgeon because its clinicalfeaturesare not prominentand the presence of main duct injurycannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. METHODS: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosedas having pancreas injury by using an explo-laparotomy. Patients successfully treated bynon-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. RESULTS: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34)). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases). Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due tomassive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively,three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. CONCLUSION: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverseoutcomes.

Predictive factors for invasive intraductal papillary mucinous neoplasm of the pancreas

BACKGROUNDS/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has malignant potential. Predicting invasive IPMN has proven difficult and controversial. We tried to identify predictive factors for invasive IPMN. METHODS: Thirty six patients underwent resection for IPMN from February 2001 to July 2011. Clinicopathological features including demographic, imaging, microscopic, and serological findings were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was used to analyze sensitivity and specificity of all possible cut-off values for the diameter of the main pancreatic duct and mass size predicting invasive IPMN. Student t-test, chi-square test, and logistic regression were used for univariate and multivariate analysis. RESULTS: The mean age was 63.5+/-8.4 years. Males were more commonly affected (58.3% vs 41.7%). Pancreaticoduodenectomy was performed in 55.6% of patients, distal pancreatectomy in 36.1%, and central pancreatic resection in 8.3%. Non-invasive IPMNs were present in 80.6% (n=29), whereas invasive IPMNs were present in 19.4% (n=7). In univariate analysis, tumor location (p=0.036), Kuroda classification (p=0.048), mural nodule (p=0.016), and main duct dilatation (> or =8 mm) (p=0.006) were statistically significant variables. ROC curve analysis showed that a value of 8 mm for the main duct dilatation and a value of 35 mm for the size of the mass lesion have 80% sensitivity and 75% specificity and 100% sensitivity and 82.6% specificity, respectively. However, in multivariate analysis, main ductal dilatation (> or =8 mm) was identified to be the only independent factor for invasive IPMN (p=0.049). CONCLUSIONS: Main duct dilatation appears to be a useful indicator for predicting invasive IPMN.

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 +/- 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.

A Case of Pancreatic Pseudocyst with an Atypical Multilocular Appearance on Endoscopic Ultrasound

Pancreatic pseudocysts are focal fluid collections that develop as a result of inflammatory diseases of the pancreas. They are managed conservatively or with a drainage procedure. Their radiological appearance can mimic cystic neoplasms of the pancreas. Pancreatic cystic neoplasms include various neoplasms with a wide range of malignant potential. Here, we report a patient with a pancreatic pseudocyst that presented with macrocystic attributes on endoscopic ultrasound.

Clinical Features and Long Term Survival of Pancreatic Neuroendocrine Tumors According to the WHO Classification

PURPOSE: Clinical features of Pancreatic Neuroendocrine Tumors (PETs) vary according to the hormone secreted and to the heredity of the tumors. Malignant PETs are common among nonfunctioning PETs (NFTs) whereas the majority of functioning PETs (FTs) are benign. Our goal was to determine the clinical features and prognosis of PETs stratified by the WHO classification scheme and AJCC-UICC 7TH TNM staging. METHODS: We selected for study 30 patients with PETs, including one case of nesidiolastosis, who presented at our clinic between April 1992 and June 2010. Clinicopathological features were studied retrospectively. PETs were classified as benign, uncertain malignant, well differentiated carcinoma, or poorly differentiated carcinomas by the WHO classification. For statistical analysis, Student's t-test, the Chi-square test, and the Kaplan-Meier method were utilized. RESULTS: Nine cases were FTs and twenty one cases were NFTs. The average size of the FTs was smaller than that of the NFTs (1.71 vs 4.33, p=0.04). The head of the pancreas was most commonly involved (33.3% of FTs; 47.6% of NFTs) but the locations of the tumors were not different. Insulinoma was the most common (66.7%, 6/9) among FTs. The incidence of malignant tumors was 33.3% and 55.0% among, respectively, FTs and NFTs. The 5-year disease-free survival rate of patients with benign PETs (FTs and NFTs), and of patients with functioning well-differentiated carcinomas was 100%. However, the 5-year disease-free survival rates of patients with nonfunctioning well- and poorly-differentiated carcinomas were 66.7% and 0%. CONCLUSION: Among patients with Pancreatic Neuroendocrine Tumors, malignant tumors are more common among NFTs than FTs. Poorly-differentiated carcinomas have a worse prognosis while all FTs regardless of their WHO classification fail to show any disease recurrence.

Comparison of Surgical Outcomes and Long-term Survival between Limited and Major Hepatic Resection for Hepatocellular Carcinoma Less than 5 cm

PURPOSE: Though major hepatic resections including hemihepatectomy, trisectionectomy, and central bisectionectomy are most commonly employed for small (<5 cm) hepatocellular carcinoma (HCC), limited hepatic resection is indicated in some HCC patients with impaired liver function, poor physical condition, or tumors peripherally located. We compared the clinicopathological features and long-term survival between the patients who underwent major resection and limited resection. METHODS: From January 1998 to May 2007, 223 patients who underwent hepatic resection for small HCC were enrolled. 123 patients underwent limited resection and 100 patients underwent major resection. Clinocopathologic features, overall, and disease-free survival were compared between both groups. RESULTS: The limited resection group had lower mean serum albumin levels (3.86+/-0.41 vs. 4.11+/-3.61, P<0.0001) and higher mean ICG R15 (12.66+/-0.87 vs. 7.51+/-4.33, P<0.0001). Patients with esophageal varix and liver cirrhosis were more common in the limited resection group (34.1% and 73.1% versus 9% and 45% respectively). Morbidity and mortality were not different in both groups. Overall 1-, 3-, 5-year survivals in both limited resection and major resection groups were 89.4%, 77.3%, 43.8% and 87.8%, 76.5%, 62.1% respectively (P=0.161) and 1-, 3-, 5-year disease free survivals were 80.2%, 50.2%, 38.6% and 79.9%, 63.2%, 50.4% respectively (P=0.10). CONCLUSION: Despite indifference of overall and disease-free 5-year survival rates between limited and major resection groups, careful follow up is essential to detect late recurrence in the limited resection group, since limited resection tends to have more frequent recurrence, especially 2 years after surgery.

Is Laparoscopic Cholecystectomy Safe in Octogenarians?

PURPOSE: Biliary tract disease is one of the most common causes of acute abdominal pain in elderly patients, but there is still some debate over treatment. The aim of this study is to determine the safety and surgical outcomes of laparoscopic cholecystectomy (LC) for benign gallbladder disease in octogenarian patients. METHODS: We selected 42 patients of 80 years or older who underwent LC or open-converted cholecystectomy (OC) from February 1992 to November 2006. We evaluated clinicopathological features, treatment modalities, and surgical outcomes retrospectively. RESULTS: The patients included 17 males and 25 females. The mean age of the patients was 83.3 and 83.7, respectively. Right upper quadrant pain was the most common symptom, present in 85.7% of the patients. Gallstones were present in 85.7%. ASA class II and III comprised 92.9% of the patients. Comorbidities included hypertension, cardiac disease, pulmonary disease, and diabetes mellitus. Preoperatively biliary drainage was performed in 12 cases (endoscopic drainage in 8, percutaneous drainage in 4 cases). Preoperative cholecystostomy was performed in 5 cases. Emergency operations were more frequent than elective surgery (25 vs. 17). Mean hospital stay of LC patients was 5 days, whereas that of OC patients was 13 days. Open conversion rate was 16.7%. No surgical mortality was present and postoperative morbidity included acute myocardial infarction in one patient and wound infection in one patient. CONCLUSION: LC in octogenarian patients was safe. However, since the incidence of comorbidities is high in these patients, great care should be taken to evaluate and manage the comorbidities before surgery.

The Impact of Concomitant Splenectomy on the Portal Pressure in Patients with Liver Cirrhosis

PURPOSE: Concomitant splenectomy in cirrhotic patients is known to ameliorate the tendency to bleed and it decreases the portal venous pressure (PVP). However, the direct measurement of the change in the PVP after concomitant splenectomy has not yet been reported. We tried to measure the change of the PVP before and after splenectomy. METHODS: From March 2000 to May 2006, 18 patients underwent anatomical liver resection with concomitant splenectomy. All the patients had liver cirrhosis, thrombocytopenia and/or esophageal varix. Through the 5 French feeding tube, which was inserted into the right gastroepiploic vein after laparotomy, we directly measured the PVP before and after splenectomy, and also under portal triad clamping (PTC). RESULTS: After splenectomy, the PVP decreased significantly from 261.11+/-45.87 mmH2O to 221.11+/-38.48 mmH2O (p<0.05). Under PTC, the PVP decreased significantly from 605.00+/-116.48 mmH2O to 513.89+/-70.56 mmH2O (p<0.05). CONCLUSION: Concomitant splenectomy in patients with liver cirrhosis resulted in a significant reduction of the PVP.