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المؤلفون: Oscar Mazza, S.H. Hyon, Eduardo de Santibañes, Juan Pekolj, Pablo E. Huespe, Martin de Santibañes, Rodrigo Sanchez-Claria, Matias E. Czerwonko, Miguel Ciardullo
المصدر: Digestive Surgery. 35:397-405
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Percutaneous, Adolescent, Group ii, Jejunostomy, Hepatic Duct, Common, Constriction, Pathologic, Anastomosis, 030218 nuclear medicine & medical imaging, Young Adult, 03 medical and health sciences, Clinical Trial Protocols as Topic, 0302 clinical medicine, Serum total bilirubin, medicine, Humans, Aspartate Aminotransferases, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Anastomosis, Surgical, Gastroenterology, Alanine Transaminase, Bilirubin, Retrospective cohort study, Middle Aged, Alkaline Phosphatase, Dilatation, Response to treatment, Surgery, Jejunum, Treatment Outcome, Balloon dilation, Female, 030211 gastroenterology & hepatology, Treatment procedure, business
الوصف: Background: Percutaneous biliary balloon dilation (PBBD) stands as a safe, useful, and inexpensive treatment procedure performed on patients with benign anastomotic stricture of Roux-en-Y hepatojejunostomy (BASH). However, the optimal mode of application is still under discussion. Methods: A retrospective cohort study was conducted including patients admitted between 2008 and 2015 with diagnosis of BASH. Patients were divided into 2 groups: group I (n = 22), included patients treated after the implementation of an institutional protocol of 3 PBBD sessions within a fixed time interval and group II (n = 24) consisted of our historical control of patients who underwent one or 2 dilation sessions. Patency at one-year post procedure was assessed with the classification proposed by Schweizer. Symptomatic response to treatment was analyzed using the Terblanche classification. Results: Patients in group I exhibited more excellent/good results (90 vs. 50%, p = 0.003) and less poor results (5 vs. 42%, p = 0.005) according to the Schweizer classification and more grade I/excellent results according to Terblanche classification (p = 0.003). Additionally, group I showed lower serum total bilirubin (p = 0.001), direct bilirubin (p = 0.002), alkaline phosphatase (p = 0.322), aspartate aminotransferase (p = 0.029), and alanine aminotransferase (p = 0.006). Conclusion: A protocol of 3 consecutive PBBD sessions within a fixed time interval may yield a high rate of patency, with a positive clinical, biochemical, and radiological impact on patients with BASH.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::13f2b0bc26c7974fc4ea542c1cd85db8
https://doi.org/10.1159/000480246 -
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المؤلفون: Ernesto P. Molmenti, Juan Pekolj, Eduardo de Santibañes, Diego Fernández, Rodrigo Sanchez Claria, Oscar Mazza, Guillermo Pfaffen
المصدر: Journal of the American College of Surgeons. 209:733-739
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Liver transplantation, environment and public health, Gastroenterology, Internal medicine, medicine, Hepatectomy, Humans, Cyst, Laparoscopy, Aged, Aged, 80 and over, medicine.diagnostic_test, Cysts, business.industry, Liver Diseases, Polycystic liver disease, Middle Aged, medicine.disease, Liver Transplantation, Surgery, Transplantation, enzymes and coenzymes (carbohydrates), Drainage, Female, lipids (amino acids, peptides, and proteins), Hepatic Cyst, biological phenomena, cell phenomena, and immunity, business, hormones, hormone substitutes, and hormone antagonists
الوصف: Background The optimal management of nonparasitic hepatic cysts (NPHC) is a topic of debate. The purpose of this study was to evaluate our 17-year experience with NPHC. Study Design From January 1990 to August 2007, 131 consecutive patients with NPHC were evaluated and treated at our institution. Seventy-eight patients (60%) had simple hepatic cysts (SHC). The remaining 53 (40%) had polycystic liver disease (PLD). Morbidity, mortality, and recurrence rates for each of the two groups were evaluated. Results Thirty-seven patients underwent open deroofing (SHC, 24; PLD,13), 66 had laparoscopic deroofing (SHC, 46; PLD, 20), 19 had percutaneous drainage (SHC, 4; PLD, 15), 3 had major hepatic resections (PLD, 3), 4 had cystojejunostomy (SHC, 4), and 2 had combined hepatorenal transplantation (PLD, 2). Corresponding morbidity, mortality, and recurrence rates were, respectively: conventional deroofing: SHC, 29%, 0%, 8%; PLD, 8%, 0%, 0%; laparoscopic deroofing: SHC, 2%, 0%, 2%; PLD, 25%, 0%, 5%; percutaneous drainage: SHC, 0%, 0%, 75%; PLD, 0%, 0%, 20%; cystojejunostomy: SHC, 75%, 0%, 25%; major hepatic resections: PLD, 66%, 0%, 0%; and hepatorenal transplantation: PLD, 50%, 50%, 0%. Conclusions Laparoscopic deroofing provided complete relief of symptoms for both SHC and PLD. Percutaneous drainage was our procedure of choice for infected liver cysts and potentially for patients who cannot tolerate general anesthesia. Liver and liver-kidney transplantations were reserved for patients with end-stage PLD alone and in association with end-stage renal disease, respectively.
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المؤلفون: de Santibañes E, Fernando A. Alvarez, Oscar Mazza, Agustin Dietrich, Rodrigo Sanchez Claria, Juan Pekolj, de Santibañes M, N. Resio
المصدر: JSLS : Journal of the Society of Laparoendoscopic Surgeons
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Common bile duct stones, Biliary drainage, Scientific Papers, Medicine, Humans, In patient, Laparoscopy, Aged, Retrospective Studies, Aged, 80 and over, Common Bile Duct, Common bile duct exploration, medicine.diagnostic_test, Common bile duct, business.industry, General surgery, Stent, Middle Aged, Biliary Tract Surgical Procedures, medicine.anatomical_structure, Choledocholithiasis, Cystic duct, Drainage, Surgery, Female, Stents, Stone removal, business
الوصف: Background: To date, the management of common bile duct stones (CBDs) is still controversial. If laparoscopic exploration is performed and biliary decompression is needed after stone removal, the placement of a laparoscopic transpapillary stent shows promising results in avoiding T-tube–related complications. Methods: Between January 2007 and May 2012, a series of 48 patients who underwent biliary decompression after laparoscopic common bile duct exploration (LCBDE) to treat choledocholithiasis was retrospectively analyzed. The results in patients with transpapillary stent placement (TS=35) were compared with those who had an external biliary drainage (EBD=13). Results: LCBDE and TS placement was achieved either by a choledochotomy or through the cystic duct. There was no mortality in our series. Patients with an external biliary drainage (EBD) had more surgery-related complications (P
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9317361911b4f60034a3edf8c2ed6b35
http://europepmc.org/articles/PMC4254483 -
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المؤلفون: Oscar Mazza, Juan Pekolj, Fernando A. Alvarez, Martín Palavecino, Rodrigo Sanchez Claria, Eduardo de Santibañes
المصدر: Journal of the American College of Surgeons. 216(5)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Percutaneous, Databases, Factual, medicine.medical_treatment, Argentina, Anastomosis, Severity of Illness Index, Cholangiography, medicine, Humans, Intraoperative Complications, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Bile duct, General surgery, Retrospective cohort study, Anastomosis, Roux-en-Y, Length of Stay, Middle Aged, Roux-en-Y anastomosis, Conversion to Open Surgery, Surgery, Biliary Tract Surgical Procedures, medicine.anatomical_structure, Jejunum, Treatment Outcome, Cholecystectomy, Laparoscopic, Liver, Drainage, Cholecystectomy, Female, Bile Ducts, business, Complication, Follow-Up Studies
الوصف: Background Bile duct injury (BDI) remains the most serious complication of laparoscopic cholecystectomy (LC). The best strategy in terms of timing of repair is still controversial. The purpose of the current study is to review the experience in the intraoperative repair of bile duct injuries sustained during LC at a high-volume referral center. Study Design Single-institution retrospective analysis of a prospectively collected database. Patients with diagnosis of BDI sustained during LC between October 1991 and November 2010 were extracted. Results Among 10,123 LC performed during the study period, 19 patients had a BDI sustained during the procedure. Intraoperative cholangiography was routinely used. Bile duct injury was diagnosed intraoperatively in 17 patients (89.4%). Mean age was 56.4 years (range 18 to 81 years) and 15 patients were women (88%). According to the Strasberg classification of BDI, there were 3 type C lesions, 12 type D lesions, and 2 type E2 lesions. There were no associated vascular injuries. Twelve cases (71%) were converted to open surgery. The repairs included 10 primary biliary closures, 4 Roux-en-Y hepaticojejunostomies, 2 end to end anastomosis, and 1 laparoscopic transpapillary drainage. Postoperative complications occurred in 5 patients (29.4%). During the follow-up period, early biliary strictures developed in 2 patients (11.7%) and were treated by percutaneous dilation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results. Conclusions The current series represents one of the largest single-center experiences in terms of intraoperative repair of BDI sustained during LC. The results suggest that a high level of intraoperative diagnosis is possible, where intraoperative cholangiography is a useful tool. The intraoperative repair of BDI sustained during LC by experienced hepatobiliary surgeons either by open or laparoscopic approach appears of paramount importance to assure optimal results.
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المؤلفون: Jeremias Goransky, Agustin Dietrich, Fernando A. Alvarez, Guillermo Arbues, Martín Palavecino, Diego Giunta, Eduardo de Santibañes, Laura Barcan, Juan Pablo Campana, Oscar Mazza, Martin de Santibañes, Juan Pekolj, Pablo Pellegrini, Rodrigo Sanchez Claria, Victoria Ardiles, Juan Glinka
المصدر: BMJ Open
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Cholecystitis, Acute, laparoscopy, Placebo, antibiotics, Young Adult, Postoperative Complications, Double-Blind Method, cholecystitis, Informed consent, Protocol, medicine, Clinical endpoint, Humans, postoperative, Adverse effect, Laparoscopy, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Standard treatment, Bacterial Infections, General Medicine, Length of Stay, Middle Aged, medicine.disease, Anti-Bacterial Agents, Surgery, Treatment Outcome, Infectious Diseases, Cholecystectomy, Laparoscopic, Research Design, Cholecystitis, Female, Cholecystectomy, business
الوصف: Introduction Acute calculous cholecystitis represents one of the most common complications of cholelithiasis. While laparoscopic cholecystectomy is the standard treatment in mild and moderate forms, the need for antibiotic therapy after surgery remains undefined. The aim of the randomised controlled Cholecystectomy Antibiotic Randomised Trial (CHART) is therefore to assess if there are benefits in the use of postoperative antibiotics in patients with mild or moderate acute cholecystitis in whom a laparoscopic cholecystectomy is performed. Methods and analysis A single-centre, double-blind, randomised trial. After screening for eligibility and informed consent, 300 patients admitted for acute calculus cholecystitis will be randomised into two groups of treatment, either receiving amoxicillin/clavulanic acid or placebo for 5 consecutive days. Postoperative evaluation will take place during the first 30 days. Postoperative infectious complications are the primary end point. Secondary end points are length of hospital stay, readmissions, need of reintervention (percutaneous or surgical reinterventions) and overall mortality. The results of this trial will provide strong evidence to either support or abandon the use of antibiotics after surgery, impacting directly in the incidence of adverse events associated with the use of antibiotics, the emergence of bacterial resistance and treatment costs. Ethics and dissemination This study and informed consent sheets have been approved by the Research Projects Evaluating Committee (CEPI) of Hospital Italiano de Buenos Aires (protocol N° 2111). Results The results of the trial will be reported in a peer-reviewed publication. Trial registration number NCT02057679.
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