Journal of hepato-biliary-pancreatic sciences
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J Hepatobiliary Pancreat Sci · Jun 2013
Multicenter StudyProposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data.
Surgical site infection (SSI) surveillance in Japan is based on the National Nosocomial Infection Surveillance system, which categorizes all hepato-biliary-pancreatic surgeries, except for cholecystectomy, into "BILI." We evaluated differences among BILI procedures to determine the optimal subdivision for SSI surveillance. ⋯ Hepatectomy and non-hepatectomy BILI differ with regard to the incidence of and risk factors for developing SSI. These surgeries should be assessed separately when conducting SSI surveillance.
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J Hepatobiliary Pancreat Sci · Apr 2013
Review Meta Analysis Comparative StudyLaparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy.
This study was performed to evaluate the outcomes of laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreatoduodenectomy (LPD) compared with the open method using meta-analysis. ⋯ This meta-analysis included the largest number of patients and number of articles comparing LDP and ODP, and LDP showed significantly better perioperative outcomes. This meta-analysis suggests that LDP is a reasonable operative method for benign tumors and some ductal carcinomas in the pancreas.
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J Hepatobiliary Pancreat Sci · Mar 2013
Ante-situm hepatic resection for tumors involving the confluence of hepatic veins and IVC.
For patients with bulky liver tumors that have invaded all three hepatic veins at the hepatic venous confluence to the inferior vena cava (IVC), reconstruction of at least one hepatic vein outlet to the IVC is necessary. ⋯ Because of the complexity of this procedure, a team of surgeons familiar with liver surgery and liver transplantation in a specialized hepatobiliary center is required. However, we anticipate that this procedure will be feasible and justified for selected patients in whom tumor invasion at the confluence of all three hepatic veins and the IVC is too extensive to treat with other surgical procedures.
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J Hepatobiliary Pancreat Sci · Feb 2013
ReviewThe learning curve in laparoscopic major liver resection.
Laparoscopic major hepatectomy remains a relatively rare operation because it is a difficult and technically demanding procedure, and a standard, safe, reproducible technique has not been widely adopted. This is compounded by "major hepatectomy" encompassing multiple different operations each with their own anatomic and procedural considerations. In 2010, we investigated our learning curve for laparoscopic liver resection. ⋯ An environment with colleagues willing to share their acquired proficiency allows the surgeon to observe and critique his or her performance against colleagues. Also, the guidance of like-minded surgeons supports technical development and improved outcomes. In conclusion, steady progress can be made along the learning curve through committed practice of increasingly complex tasks and with proper coaching in a high-volume environment.
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J Hepatobiliary Pancreat Sci · Feb 2013
ReviewGas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy?
Laparoscopic hepatectomy (LH) has become popular as a surgical treatment for liver diseases, and numerous recent studies indicate that it is safe and has advantages in selected patients. Because of the magnified view offered by the laparoscope under pneumoperitoneal pressure, LH results in less bleeding than open laparotomy. ⋯ At many high-volume centers, LH is performed at a pneumoperitoneal pressure less than 12 mmHg, and reports indicate that the rate of clinically severe gas embolism is low. However, more studies will be necessary to elucidate the optimal pneumoperitoneal pressure and the incidence of gas embolism during LH.