Research progress in liver transplantation in patients with situs inversus totalis / 器官移植

Situs inversus totalis (SIT) is a rare congenital condition, with an extremely low incidence. There is no difference between SIT individuals without onset of diseases and healthy counterparts. However, when SIT individuals suffer from diseases, the diagnosis and treatment are highly challenging due to insufficient understanding of SIT populations, especially for those complicated with end-stage liver disease and requiring liver transplantation. It is a huge challenge for surgeons whether SIT individuals serve as donors or recipients of liver transplantation. In this article, recent case reports related to liver transplantation in SIT patients were summarized, and the development, key procedures, clinical prognosis and postoperative complications of liver transplantation in SIT patients were reviewed.

Tratamiento quirúrgico inmediato en niños con perforación espontánea de la vía biliar. Experiencias de 16 años

Introducción: La perforación espontánea de los conductos biliares es una rara enfermedad caracterizada por una disrupción no traumática de la vía biliar en pacientes aparentemente sanos. Se trata de una grave situación potencialmente letal, pero diagnosticada y tratada correctamente tiene un pronóstico excelente. Objetivo: Caracterizar los principales elementos clínico-quirúrgicos expresados en una serie de 5 pacientes operados en un servicio de referencia nacional. Presentación de casos: Se presenta la experiencia con una serie de casos en 16 años en una sola institución. La afección se observó en niñas recién nacidas y lactantes con una edad media de 4 meses, y se presentó desde la clínica como una colestasis acompañada de distensión abdominal, ascitis biliar, acolia, y signos de irritación peritoneal. El 80 % de los casos se intervinieron en el hospital "William Soler", y en un caso se ejecutó el procedimiento después de una laparotomía por una posible apendicitis aguda, en otro hospital. El diagnóstico se basó en el cuadro clínico descrito, la ecografía abdominal, la paracentesis con medición del índice bilirrubina líquido ascítico/bilirrubina sérica, y la colangiografía intraoperatoria. La cirugía definitiva se realizó inmediatamente, y consistió en: lavado peritoneal, colangiografía diagnóstica, reparación hepaticoyeyunostomía en Y de Roux y colocación de drenaje. Conclusiones: El tratamiento realizado resulta eficaz y seguro en todos los casos, con una excelente evolución, sin complicaciones importantes y con una total supervivencia posoperatoria. La colangiografía intraoperatoria permitió identificar el sitio de la perforación y diagnosticar malformaciones asociadas como dilataciones biliares congénitas y anomalías de la unión bilio-pancreática.

Introduction: Spontaneous bile duct perforation is a rare condition characterized by non-traumatic disruption of the bile duct in apparently healthy patients. It is a serious potentially lethal situation, but correctly diagnosed and treated its prognosis is excellent. Objetive: To characterize the main clinical-surgical elements expressed in a series of 5 patients operated in a national referral service. Case presentation: The experience with a series of cases during a period of 16 years in a single institution is presented. The condition was observed mainly in newborn girls and infants with an average age of 4 months, and presented clinically as cholestasis accompanied by abdominal distension, biliary ascites, acholia, and signs of peritoneal irritation. 80% of the cases were operated primarily in the "William Soler" hospital, and in one case the procedure was performed after a laparotomy for a possible acute appendicitis, in another hospital. The diagnosis was based on the clinical picture described, abdominal ultrasound, paracentesis with measurement of the ascitic liquid bilirubin/serum bilirubin index, and intraoperative cholangiography. Definitive surgery was performed immediately and consisted of: peritoneal lavage, diagnostic cholangiography, Roux-en-Y liver and jejunostomy repair and drainage placement. Conclusions: The treatment performed was effective and safe in all cases, with an excellent evolution, no major complications and total postoperative survival. Intraoperative cholangiography made it possible to identify the site of perforation and to diagnose associated malformations such as congenital biliary dilatations and anomalies of the biliary-pancreatic junction.

Laparoscopic Choledochal Cyst Excision with Hepaticoduo-denostomy: An Experience

Background: Standard treatment for choledochal cyst (CDC) is excision of cyst with biloenteric reconstruction. Most common methods of reconstruction following CDC excision are Roux en y hepaticojejunostomy (RYHJ) and Hepaticoduodenostomy (HD). Although HD has been employed in paediatric population, its use in adult patients has been limited. Aim: The aim of the study was to analyse our experience of patients who underwent laparoscopic excision of CDC and to compare the short term and long term outcomes following HD versus RYHJ as a method of reconstruction in adults. Methods: This is a retrospective analysis of prospectively collected data of 65 patients who underwent laparoscopic cyst excision from January 2016 to March 2021in a single surgical unit at GB Pant Institute of Post graduate Medical Education and Research, New Delhi. Following CDC excision HD was our preferred as method of biliary reconstruction. Patients with restricted duodenal mobility and thin friable duct underwent RYHJ.Short-term outcomes included operative time,blood loss, length of hospital stay and complications such as anastomotic leakage and post operative bleeding.Long-term outcomes included anastomotic stricture formation and need for redo biliary reconstruction. Results: Total 65 patient underwent laparoscopic CDC excision. Mean age was 31.66 ± 12.77years and male: female ratio was 1:5.4. Type I cyst was the most common (60/65=92.3%) with mean size of 2.59 ±0.78cm. Laparoscopic HD was feasible in 87% (57/65) of patients. RYHJ was done in 8 patients. Outcome in laparoscopic HD vs RYHJ group: Mean blood loss was 54.22±8.9ml vs 92±16 mL, mean operative time was 182±41.6 vs 240±52.2 mL, mean hospital stay was 4±2.1 vs 5±3.2 days. There was no difference in anastomotic leak rate (3 vs 1, p=0.42) or post-operative bleeding rate between the two groups.There was no perioperative mortality. Conclusion: Laparoscopic HD was feasible in most of the adult CDC patients with better short term and comparable long term results.It may be used as the preferred biliary reconstruction method during laparoscopic CDC excision in adults as it is technically easier, requires single anastomosis and also accessible for future endoscopic intervention.

Síndrome de Mirizzi tipo V, entidad infrecuente y compleja / Mirizzi's syndrome type V, a rare and complex entity

El síndrome de Mirizzi es una inflamación poco frecuente y crónica ocasionada por un cálculo impactado en la bolsa de Hartmann con obstrucción parcial o completa del conducto biliar principal, que infiere un difícil diagnóstico preoperatorio y controversial manejo terapéutico. El objetivo del trabajo fue exponer el tratamiento de cinco pacientes con diagnóstico de síndrome de Mirizzi tipo V. Se realizó una revisión de las bases de datos Pubmed, Dynamed y Conchrane en busca de artículos relacionados. Se presentó el tratamiento de esta entidad en cinco pacientes teniendo en cuenta la experiencia del autor y los hallazgos de la revisión realizada. La cirugía convencional es la vía ideal de acceso para el tratamiento de esta entidad utilizando las derivaciones bilioentéricas en sus variantes. Un alto índice de sospecha se requiere para un diagnóstico preoperatorio e intraoperatorio certero, con una óptima planificación quirúrgica(AU)

Mirizzi's syndrome is a rare and chronic inflammation caused by a gallstone impacted in the Hartmann's pouch with partial or complete obstruction of the main bile duct, which results in difficult preoperative diagnosis and controversial therapeutic management. To present the treatment of five patients diagnosed with Mirizzi's syndrome type V. A search for articles was carried out in the databases Pubmed, Dynamed and Conchrane. The treatment of this entity was presented in five patients, taking into account the author´s experience of the review´s findings. Conventional surgery is the ideal access route for this entity´s treatment using bilioenteric bypass in its variants. A high index of suspicion is required for accurate preoperative and intraoperative diagnosis, with optimal surgical planning(AU)

A meta-analysis of the biliary complications in adult living donor liver transplantation to compare duct-to-duct hepaticocholedochostomy with Roux-en-Y hepaticojejunostomy biliary reconstruction / 中华肝胆外科杂志

Objective To compare the incidences of biliary complication after adult living donor liver transplantation (ALDLT) using Roux-en-Y hepaticojejunostomy (R-Y HJ) with duct-to-duct hepaticocholedochostomy (D-D HC).Methods A meta-analysis was conducted by searching the Medline-PubMed,EMBASE,Scielo-LILACS,and Cochrane Databases.A comparison using 95％ confidence intervals was performed on different biliary reconstruction techniques in liver transplantation with regard to occurrence of biliary complications.Results According to our predetermined inclusion and exclusion criteria,seven clinical studies were selected to compare D-D HC with R-Y HJ.The overall biliary comphcation rates,biliary stricture rates and biliary leakage rates were compared.The overall biliary complication rate and the biliary stricture rate of R-Y HJ were significantly less than D-D HC,but the biliary leakage rate of R-Y HJ was similar with the D-D HC (overall biliary complication rate P ＜ 0.05,OR =0.35,95％ CI:0.15 ～ 0.81,I2 =28％ ; biliary stricture rate P ＜ 0.05,OR =0.43,95％ CI:0.29 ～ 0.65,I2 =49％ ; biliary leakage rate P=0.05,OR=1.62,95％ CI:1.01 ～2.60,I2 =19％).Conclusions The meta-analysis showed that biliary reconstruction in ALDLT should be performed using R-Y HJ.