Hepato Gastroenterol
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Hepato Gastroenterol · Sep 2004
Risk factors of pancreatic fistula following pancreaticoduodenectomy for periampullary cancer.
Pancreatic fistula remains one of the most common complications of pancreaticoduodenectomy. This study was carried out to identify relevant risk factors for the development of pancreatic fistula and to evaluate whether prophylactic administration of octreotide decreases their incidence. ⋯ The only surgeon-dependent factor which may reduce the incidence of stump-related complications is anastomosis of the pancreatic remnant with the alimentary tract. Carried out single-institution analysis showed octreotide to be ineffective in the prevention of pancreatic fistula following pancreaticoduodenectomy.
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Hepato Gastroenterol · Sep 2004
Case ReportsHilar bile duct cancer associated with preoperatively undetectable von Meyenburg complex--report of a case.
A 56-year-old man was admitted to our hospital with a diagnosis of hilar bile duct cancer. Abdominal ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography showed no other concomitant disease. Biochemical data showed 0.6 mg/dL of total bilirubin, 104 IU/L of alanine aminotransferase and 469 mg/dL of alkaline phosphatase. ⋯ The possibility of a preoperative imaging diagnosis for von Meyenburg complex seems to depend on the size of the bile duct structure in each hamartoma. To the best of our knowledge, this is the fourteenth case of bile duct cancer associated with von Meyenburg complex reported in the literature. The following case is being reported because of the rarity of the disease and to stress the importance of intraoperative histology to avoid misdiagnosis as the disseminated disease, particularly when malignant neoplasia is surgically treated.
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Hepato Gastroenterol · Sep 2004
Case ReportsSurgery for hepatocellular carcinoma with tumor thrombus extending into the right atrium: report of a successful resection without the use of cardiopulmonary bypass.
Hepatocellular carcinomas, of which the tumor thrombus extends into the right atrium via the inferior vena cava, may soon cause fatal complications. Only surgery can be an effective treatment. This procedure usually needs the aid of cardiopulmonary bypass. ⋯ Preoperative or intraoperative US is essential in judging whether tumor thrombus can be removed from the right atrium into the inferior vena cava by reducing the liver or not. Test clamping of the inferior vena cava prior to total hepatic vascular exclusion will enable us to judge whether veno-venous bypass during total hepatic vascular exclusion is needed or not. Surgery without the use of cardiopulmonary bypass is safe and can be minimally invasive when it is performed with a reliable diagnosis and technique.
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Bile leak remains a serious complication after major hepatectomy. The usefulness of external biliary drainage to prevent intraperitoneal bile leak was studied. ⋯ Though some patients had bile leakage even with the RTBD tube, use of the RTBD tube decreased the length of time leakage that occurred. RTBD tube drainage should be done routinely with major hepatectomy.
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Hepato Gastroenterol · Sep 2004
Comparative StudyLaparoscopic and open approach in perforated peptic ulcer.
To improve the perioperative course and quality of life of the patients with perforated peptic ulcer, we investigated the conversion risk factors in laparoscopic simple closure and omental patch repair for perforated peptic ulcer. ⋯ These conversion factors are useful to achieve appropriate surgical treatments for perforated peptic ulcer.