INTRODUÇÃO Os procedimentos abdominais eletivos em pacientes cirróticos, dentre os quais correção cirúrgica de hérnias de parede abdominal, têm sido amplamente desencorajados, devido à elevada morbi-mortalidade consequente às complicações da cirrose. Elas incluem trombocitopenia, coagulopatia, ascite, hipertensão portal, insuficiência renal, entre outras. Além disso, é possível observar risco aumentado de descompensação hepática pós-cirúrgica e possibilidade de prejuízo na cicatrização de feridas resultantes de seu frequente mal estado nutricional17. A estratificação
Background: The laparoscopic approach to liver resective surgery is slowly spreading to specialized centers. Little is known about factors influencing the immediate postoperative outcome. Study Design: The purpose of the study was to evaluate the immediate outcome of laparoscopic liver resection (LLR), with particular emphasis on intraoperative bleeding and conversion. A retrospective analysis of demographic, clinical, and surgical data, including conversion, morbidity/mortality, and hospital stay, of the first 100 patients at our institution undergoing LLR from February 1997 through March 2007
INTRODUÇÃO A trombose de veia porta (TVP) em candidatos ao transplante hepático, até passado recente, era considerada contraindicação absoluta para o transplante em razão das dificuldades técnicas e da alta mortalidade34. Foi apenas em 1985 que Shaw et al. relataram o primeiro caso bem sucedido27. Atualmente, com o desenvolvimento de estratégias para vascularização portal do enxerto e refinamento da técnica operatória, o transplante de fígado em pacientes portadores de
INTRODUCTION Graft-versus-host disease (GVHD) following liver transplantation (LT) is an uncommon complication but has high mortality and represents a major diagnostic challenge. GVHD occurs when immunocompetent donor lymphocytes originating from the transplanted liver undergo activation and clonal expansion, allowing them to mount a destructive cellular immune response against recipient tissues. Humoral GVHD is usually seen after an ABO-mismatched liver transplant, but cellular GVHD is directed against the major histocompatibility complex and often results
INTRODUCTION Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome with autoimmune features and is associated with other immunological diseases such as autoimmune pancreatitis and inflammatory bowel disease. In addition to primary biliary cirrhosis, PSC is one of the most common chronic cholestatic liver diseases.1 The diagnosis of PSC is a challenge because patients are asymptomatic or display unspecific symptoms. Patients experience fatigue, pruritus, and jaundice. In addition,
Background Abdominal hernias are a common disease among cirrhotic patients, because of malnutrition and persistently high intra-abdominal pressure due to ascites. When tense ascites is present, life-threatening complications are likely to occur. In such cases, the morbidity and mortality rates are high. Objective We describe 3 cirrhotic patients with rare complicated hernias that needed surgical repair. We discuss optimal timing for surgical approaches and the necessity of ascites control before surgery, as well as the technical details of the procedures. Method Review of hospital charts
INTRODUCTION In the last thirty years, hepatic steatosis has been well-documented as the most common chronic liver disease in the general population. Its high prevalence is of epidemiological concern because it affects 31% of adults as evaluated by magnetic resonance imaging in the USA1 and 33% of living donor candidates who underwent liver biopsy.2 The prevalence is directly related to age and varies from 2.6% in children to 26% in adults who are
INTRODUCTION Liver transplantation (LT) techniques have changed continually over the last 4 decades. Caval preservation, first reported by Calne and Williams in 19681 and popularized by Tzakis et al. in 19892 as the piggyback (PB) technique, has been adopted by many transplant teams.3–6 In 1992, we described a procedure preserving the caval flow during
INTRODUCTION In acute pancreatitis (AP), severity and prognosis are directly related with the intensity of the initial damage.1 In 15% of cases, the pancreatic lesion is severe and the mortality varies from 10 to 100%, being greater in those cases where the pancreas is necrotic and infected. Such patients require intensive care for a longer period as well as multiple surgical interventions.2-6 The systemic inflammatory response and the medical care of these patients
INTRODUCTION Unlike arterial aneurysms, primary venous aneurysms are uncommon. Venous aneurysms have been found and described in the popliteal, jugular, and saphenous veins, but occur only rarely in other veins. Portal vein aneurysms represent less than 3% of all venous aneurysms.1 This finding has been increasingly described in recent years probably because radiologic imaging exams are more available in clinical practice. Two forms, congenital and acquired, have been described. Acquired aneurysms are