Browsing by Author "Karamarković, Aleksandar (6507164080)"

Background/Aims: Liver resections are still one of the most challenging operations. The aim of this study was to analyze the efficiency and safety of the intrahepatic Glissonean pedicle approach vs. classical Hilar dissection in major hepatectomies. Methodology: Thirty-four patients were assigned to the Glissonean approach (GA, n=34), while the Hilar dissection were assessed as historical control, matched for the age, gender, comorbidities and Child-Pugh score (HD, n=34). Results: The GA was associated with significantly shorter surgery duration (191.18±41.10 vs. 246.62± 56.55), transection time (38.94±14.56 vs. 56.32±19.40) and ischemic duration (26.03±11.27 vs. 41.18±12.80) than HD (p<0.001 for all). The amount of blood loss was significantly lower in GA (245.59±169.39 vs. 344.71±166.25; p=0.018). The amount of blood transfusion was significantly lower in GA during surgery (322.86±102.07 vs. 414.76±135.48) as well as postoperatively than HD (246.67±5.77 vs. 336.67±120.55) (p=0.038 and p=0.026. respectively). Conclusions: Major hepatectomy can be performed more easily using the Glissonean pedicle approach than by hilar dissection. En-masse transection of pedicles, as well as hepatic veins, using endo-GIA vascular stapler could be performed safely. Liver surgeons should know the Glissonean pedicle approach. © H.G.E. Update Medical Publishing S.A.

Background and aims: The present study attempted to identify the diagnostic significance of procalcitonin (PCT) in acute abdominal conditions as well as the range of concentrations relating to diagnosis of abdominal sepsis. Materials and methods: This was prospective clinical study. The study included 98 consecutive patients with acute abdominal conditions, divided in sepsis and systemic inflammatory response syndrome (SIRS) group. Results: PCT concentrations on admission were significantly higher in the sepsis group than in the SIRS group (median [interquartile range] 2.32 [7.41] vs 0.45 ng/ml [2.62]). A cutoff value of 1.1 ng/ml yielded 72.4% sensitivity and 62.5% specificity. In a group of patients with abdominal symptoms lasting for more than 24 h, a cut-off value of 1.1 ng/ml yielded higher sensitivity (82.9%) and higher specificity (77.3%). Conclusion: Our results suggest that PCT measurements may be useful for early, preoperative diagnosis of abdominal sepsis. © 2007 Springer-Verlag.

Introduction Despite the fact that treatment of liver injuries has dramatically evolved, severe liver traumas in polytraumatic patients still have a significant morbidity and mortality. Objective The purpose of this study was to determine the options for surgical management of severe liver trauma as well as the outcome. Methods In this retrospective study 70 polytraumatic patients with severe (American Association for the Surgery of Trauma [AAST] grade III–V) blunt liver injuries were operated on at the Clinic for Emergency Surgery. Results Mean age of patients was 48.26±16.80 years; 82.8% of patients were male. Road traffic accident was the leading cause of trauma, seen in 63 patients (90.0%). Primary repair was performed in 36 patients (51.4%), while damage control with perihepatic packing was done in 34 (48.6%). Complications related to the liver occurred in 14 patients (20.0%). Liver related mortality was 17.1%. Non-survivors had a significantly higher AAST grade (p=0.0001), higher aspartate aminotransferase level (p=0.01), lower hemoglobin level (p=0.0001), associated brain injury (p=0.0001), perioperative complications (p=0.001) and higher transfusion score (p=0.0001). The most common cause of mortality in the “early period” was uncontrolled bleeding, in the “late period” mortality was caused by sepsis and acute respiratory distress syndrome. Conclusion Patients with high-grade liver trauma who present with hemorrhagic shock and associated severe injury should be managed operatively. Mortality from liver trauma is high for patients with higher AAST grade of injury, associated brain injury and massive transfusion score. © 2015, Serbia Medical Society. All rights reserved.

Introduction Hemangioma is the most frequent benign solid tumor of the liver. It is well known that a giant liver hemangioma carries the risk of spontaneous rupture, followed by hemoperitoneum and hemorrhagic shock with possible fatal outcome. Case Outline This is a case report of the spontaneous rupture of a giant cavernous hemangioma of the liver in an 85-year old patient. The patient was presented with abdominal pain and hemorrhagic shock. Emergency ultrasonography and computed tomography of the abdomen showed a heterogeneous ruptured solid tumor of the right liver lobe, multiple cysts in the left lobe and massive hemoperitoneum. The patient was successfully managed by immediate exploratory laparotomy, surgical enucleation of the hemangioma under intermittent inflow vascular occlusion, temporary perihepatic packing and planned second look relaparotomy. Conclusion Immediate surgical procedure is indicated mandatory in unstable patients with a ruptured giant hemangioma of the liver. Surgical enucleation under intermittent inflow vascular occlusion and temporary perihepatic packing could be a life-saving procedure in those patients.

Background: Severe liver injury in trauma patients still accounts for significant morbidity and mortality. Operative techniques in liver trauma are some of the most challenging. They include the broad and complex area, from damage control to liver resection. Material and method: This is a retrospective study of 121 trauma patients with hepatic trauma American Association for Surgery of Trauma (AAST) grade III-V who have undergone surgery. Indications for surgery include refractory hypotension not responding to resuscitation due to uncontrolled hemorrhage from liver trauma; massive hemoperitonem on Focused assessment by ultrasound for trauma (FAST) and/or Diagnostic peritoneal lavage (DPL) as well as Multislice Computed Tomography (MSCT) findings of the severe liver injury and major vascular injuries with active bleeding. Results: Non-survivors have significantly higher AAST grade of liver injury and higher Injury Severity Score (ISS) (p=0.000; p=0.0001). Non-survivors have significant hypotension on arrival and lower Glasgow Coma Scale (GCS) on admission (p=0.000; p=0.0001). Definitive hepatic repair was performed in 62(51.2%) patient. Damage Control, liver packing and planned re-laparotomy after 48h were used in 59(48.8%). There was no statistically significant difference in terms of the surgical approach. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24h between survivors and non-survivors (p=0.001). Overall mortality rate was 33.1%. Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p=0.0001; p=0.0001), while survivors had significantly higher rate of pleural effusion (p=0.0001). Conclusion: All efforts in the treatment of severe liver injuries should be directed to the rapid and effective control of bleeding, because uncontrollable hemorrhage is the cause of early death and it requires massive blood transfusion, all of which contributes to the late fatal complication. © 2015 Doklestić et al.

Background/Aims: Liver resection is a demanding procedure due to the risk of massive blood loss. Different instruments for liver transection are available today. The aim of this randomized clinical trial was to analyze the efficacy of three different parenchyma transection techniques of liver resection. Methodology: A total of 60 non-cirrhotic patients undergoing hepatectomy were randomly selected for clamp crushing technique (CRUSH), ultrasonic dissection (CUSA) or bipolar device (LigaSure), n=20 in each group. All patients had liver resection under low central venous pressure anaesthesia (CVP), with ischemic preconditioning and intermittent inflow occlusion. Primary endpoints were surgery duration, transection duration, cumulative pedicle clamping time, intraoperative blood loss and blood transfusion. Secondary endpoints included the postoperative liver injury, postoperative morbidity and mortality. Results: Overall surgery duration was 295 vs. 270 vs. 240min for LigaSure, CUSA and Clamp Crushing Technique, respectively. The transection duration was 85 vs. 52.5 vs. 40 minutes, respectively. These three different resection techniques of non-cirrhotic liver produced similar outcome in terms of intraoperative blood loss, blood transfusion, postoperative complications and mortality. Conclusions: The Clump Crushing Technique, CUSA and Liga Sure are equally safe for resection of non-cirrhotic liver. Liver resections can be performed safely if the entire concept is well designed and the choice of dissection device does not affect the outcome of hepatectomy. © H.G.E. Update Medical Publishing S.A.

The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy of the liver and advances the technique of liver surgery. Extrafascial dissection of Glissonean pedicle without opening the liver substance, proposed by Takasaki, represents an effective and safe technique of anatomic liver resection. Presented approach allows early and easy ischemic delineation of appropriate anatomic liver territory (hemiliver, section or segment) to be removed with selective inflow vascular control. It is not time consuming and it is very useful in re-resection, as well as oncological reasonable. According to the Sugioka’s proposal, for technical standardization, it is important to recognize the four anatomical landmarks; the Arantius plate, the umbilical plate, the cystic plate and the Glissonean pedicle of the caudate process (G1c), and six Gates defined by the four anatomical landmarks. For the right extrahepatic Glissonean pedicle isolation, the cystic plate cholecystectomy should be the first procedure, whereas for the left, Arantius plate or the umbilical plate should be detached from Laennec’s capsule at first. Pedicles can be isolated by connecting Gates each other. Further peripheral pedicles could be pulled out to the hepatic hilum and transected safely. In conclusion, the extrahepatic Glissonean pedicle approach based on Laennec’s capsule would standardize anatomical liver resection including laparoscopic and robotic liver resection. Copyright © Celsius Publishing House