Hepato Gastroenterol
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Hepato Gastroenterol · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialThe value of omentoplasty in protecting colorectal anastomosis from leakage. A prospective randomized study in 126 patients.
Anastomotic leakage is a major cause of mortality in colorectal surgery. Several methods have been evaluated in order to prevent anastomotic leakage. To decrease the rate and severity of anastomotic leakage, omentoplasty (OP) has been proposed by several authors on the basis of experimental and clinical studies. A prospective, randomized trial was designed to study the influence of omentoplasty on anastomotic leakage after colorectal resection. ⋯ Omental wrap, with its mechanical and biological properties, seems to be effective in lowering the rate and the severity of anastomotic leakage after colorectal surgery.
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Hepato Gastroenterol · Nov 2004
Comparative StudySimultaneous percutaneous right portal vein embolization and left liver tumor radiofrequency ablation prior to a major right hepatic resection for bilateral colorectal metastases.
Hepatic resection offers the best chance of survival for patients with liver metastases (LM) of colorectal origin. However, some patients are not eligible for surgery because of a too small future liver remnant (FLR) which carries a high risk of severe postoperative liver failure. The operability status of these patients can be favorably changed by selective right portal vein embolization (PVE) which induces compensatory growth of the left liver. However, during liver regeneration following right PVE, the left LM growth rate is faster than that of the non-embolized normal liver parenchyma. This study aimed at examining an approach for those patients in which there is bilateral LM potentially resectable following portal vein embolization, but in which there is a risk of rapid liver metastasis growth in the non-embolized liver. ⋯ Simultaneous percutaneous right PVE and left RFA is feasible. This procedure allowed good left-sided tumor control during liver growth following PVE in all five patients. It is the most logical procedure for patients with bilateral colorectal LM needing right PVE before resection, if the left concomitant LM is small and accessible to percutaneous RFA. This procedure should be preferred because it eliminates the risk of left LM growth during the 1-month interval between PVE and surgery.
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Hepato Gastroenterol · Nov 2004
Comparative StudyPreoperative plasma fibrinogen levels in gastric cancer patients correlate with extent of tumor.
The aim of the present study was to investigate the relationship between the preoperative plasma fibrinogen level and the extent of tumor involvement in gastric cancer patients. ⋯ These data suggest that the plasma fibrinogen level is a clinically important and useful marker of the extent of tumor progression in gastric cancer.
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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.