Changed Address

Due to certain problems with Blogger.com, I have decided to change address for this blog. I will try to keep the blogger site updated, but Hepatobiliary Surgery and Liver Transplantation will continue here. You can also visit the spanish version here. If you want to continue receiving information, please subscribe to the new english version. Thank you for your comprehension.

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Improved Operation Planning by 3-D Reconstruction and Computer-Assisted Imaging

A multi-institutional publication was issued in this month's Journal of the American College of Surgeons. It involved a 74-year-old man presented with a solitary colorectal metastasis
in the cranial part of the liver involving segments IVa/IVb/VIII and the middle hepatic vein (MHV).

CT scan showed a small right hepatic vein (RHV) in the presence of an inferior right hepatic vein and that tumor resection was possible by an extended left hepatectomy with preservation of the small RHV and the inferior right hepatic vein.

The calculated future liver remnant was large, about 45% of total liver volume, but a precise assessment of its venous drainage was not possible by CT scan. For better prediction, 3-D reconstruction of the liver anatomy and computer-assisted analysis were performed, revealing the RHV draining 20%, IRHV 32%, MHV 35%, LHV 12%, and caudate lobe veins 1% of total liver volume. At operation, the tumor was removed by an extended left hepatectomy, preserving the RHV and the IRHV.



These new techniques gave much more detailed information of the patient’s individual anatomy than conventional CT Image-based computer assistance and 3-D reconstruction may be particularly useful for planning liver resections with vascular anatomic variations.

JACS. Vol. 205, No. 4, October 2007

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Liver Manipulation Causes Hepatocyte Injury and Precedes

The Department of Surgery of the Maastricht University Hospital, Netherlands, published an article in this month's issue of the World Journal of Surgery.

The aim of this study was to elucidate the causes of hepatocellular injury in patients undergoing liver resection.Markers of hepatocyte injury (AST, GSTa, and L-FABP) and inflammation (IL-6) were measured in plasma of patients undergoing liver resection with and without intermittent inflow occlusion.

During liver manipulation, liver injury markers increased significantly. Intermittent hepatic
inflow occlusion, anesthesia, and liver transection did not further enhance arterial L-FABP and GSTa levels. Hepatocyte injury was followed by an inflammatory response.

This study shows that liver manipulation is a leading cause of hepatocyte injury during liver surgery. A potential causal relation between liver manipulation and systemic inflammation remains to be established; but since the inflammatory response is apparently initiated early
during major abdominal surgery, interventions aimed at reducing postoperative inflammation and related complications should be started early during surgery or beforehand.

World J Surg (2007) 31:2033–2038

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Randomized Study of the Benefits of Preoperative Cosrticosteroid Administration on Hepatic I/R Injury

The Liver Unit of the Department of Surgery at the Milan University, Italy, published in September's issue of HPB journal a study which aimed at determining wether steroid administration may reduce liver injury and improve short term outcome.

The study included 43 patients undergoing liver resection, randomizing the groups to steroid receiving patients and a control group. Patients receiving steroids, were given 500 mg of methylprednisolone preoperatively. Levels of ALT, AST, total bilirubin, AT-III, PT, IL-6, TNF alfa were compared. Length of stay and complications were recorded.

Postoperative serum levels of ALT,AST, total bilirubin, inflammatory cytokines were lower in the steroid group. The incidence of postoperative complications in the control group tended to be higher than the steroid group.

The study concluded that steroid pretreatment represents a potentially important biologic modifier of I/R injury and may contribute to maintenance of coagulant/anticoagulant homeostasis.


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Microbiological Assessment of Bile During Cholecystectomy: Is All Bile Infected?

The Department of Surgery of the West Wales University, published in the September edtion of the Journal of the International Hepato Pancreato Biliary Association (HPB), a very interesting study. The aim was to determine the prevalence of bactibilia in patients undergoing cholecystectomy and to relate the presence or absence of organisms to the preoperative and postoperative course.

A total of 180 patients were collected, all being cholecystectomized during a 5 year period by a same surgeon. Risk factors for bactibilia (acute cholecystitis, common duct stones, emergency surgery, age > 70 years) were documented.

Seventy percent of the patients had complete data. Bacteria were identified in 15,6 % of cases. All patients had at least 1 risk factor. The overall incidence of infective complications was 20%. This study demonstrated that patients with uncomplicated choleclithiasis have aseptic bile. This sugests that use of prophylactic antibiotics should be limited to patients with risk factors for bactibilia.

HPB 2007; 9: 225-228

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