Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual ... more Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual present as an incidental finding. The diagnosis can be made during the evaluation of chronic abdominal pain in the right lower quadrant or may emerge in the pathology report in the setting of an acute appendicitis.Appendectomy is the treatment of choice and care must be taken to avoid perforation of the appendix with dissemination of neoplastic cells or mucus into the peritoneum and thus prevent the development of pseudomyxoma peritonei.
Journal of Laparoendoscopic & Advanced Surgical Techniques, Oct 1, 2018
The initial mortality rates of associating liver partition and portal vein occlusion for staged h... more The initial mortality rates of associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) were high. However, recent data from the International Registry show a continuous reduction of early mortality and major morbidity due to risk adjustment in patient selection and less invasive techniques in stage-1 surgery. During the first ALPPS International Consensus in 2015, we introduced a paradigm inversion of ALPPS, the so-called "Mini-ALPPS." We combined a partial liver partition with a novel technique of laparoscopic-assisted percutaneous cannulation of the inferior mesenteric vein for intraoperative transmesenteric portal vein embolization. We report here for the first time, a case of a successful totally laparoscopic Mini-ALPPS, and describe in detail the technical aspects of this new approach. A 61-year-old man with a 6 cm hepatocellular carcinoma compromising the right glissonian pedicle in a fibrotic liver was treated by an extended right hepatectomy using the laparoscopic Mini-ALPPS approach. The patient had an uneventful first stage and was discharged 3 days after. A CT scan performed on postoperative day 8 showed sufficient future liver remnant volume after a 59% hypertrophy. An extended right hepatectomy was uneventfully completed and the patient was discharged 5 days after surgery. The histopathological analysis indicated advanced F4 liver fibrosis and negative tumor margins. This technical innovation allows avoiding a laparotomy to access the mesenteric venous territory and the risks of liver remnant injuries during percutaneous transhepatic approach. This new alternative may result of great utility not only in ALPPS but also for many different circumstances and scenarios.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The surgical strategy to resolve the underlying biliary pathology in patients with acute gallston... more The surgical strategy to resolve the underlying biliary pathology in patients with acute gallstone pancreatitis (AGP) remains controversial. The aim of this study was to evaluate the safety and effectiveness of early laparoscopic cholecystectomy (ELC) in patients with mild AGP. A retrospective cohort of consecutive patients diagnosed with mild AGP according to the Atlanta Guidelines from January 2009 to July 2019 was selected. Patients were assigned to surgery on the first available surgical shift, 48 h after the symptoms onset. Univariate analysis was performed to determine the association between AGP and grades of Balthazar (A, B and C) with time to surgery, days of hospitalization and postoperative complications. From 239 patients evaluated, 238 (99.58%) were operated by laparoscopic approach. Intraoperative cholangiogram was performed routinely. Choledocholithiasis, if present, was successfully treated by laparoscopic common bile duct exploration in all cases. A significant association was found between Balthazar grades and time to surgery (median of 3 days, p = 0.003), with length hospitalization and from surgery to discharge, with median of 4 days (p = 0.0001) and 2 days (p = 0.003), respectively. Mild postoperative complications (CD I/II) were observed in 22/239 patients (9.2%). This represents 2% of patients with grade A of Balthazar, 9% of grade B and 14% of grade C (p = 0.016). We observed no severe complications or mortality. ELC with routine intraoperative cholangiogram, performed on the first available surgical shift 48 h after the symptoms of pancreatitis onset, is a viable, effective and safe strategy for the resolution of mild AGP and its underlying biliary pathology in a single procedure.
LT has become the treatment of choice for children with end‐stage liver disease. The scarcity of ... more LT has become the treatment of choice for children with end‐stage liver disease. The scarcity of donors and the considerable mortality on waiting lists have propelled the related living‐donor techniques, especially in small children. This population need smaller and good quality grafts and are usually candidates to receive a LLS from a related donor. Many times this grafts are still large and do not fit in the receptor's abdomen, so a further hyper‐reduction may be required. Despite all advances in LT field, vascular complications still occur in a considerable proportion remaining as a significant cause of morbidity, graft loss, and mortality. Technical issues currently play an essential role in its genesis. The widely spread technique for biliary and vascular reconstruction in living donor LT (LDLT) nowadays implies removal of the portal vein (PV) clamp after the venous anastomosis, then the arterial reconstruction is done, followed by the biliary reconstruction. However, due t...
A double-blind randomized controlled trial was performed to compare the safety and efficacy of α-... more A double-blind randomized controlled trial was performed to compare the safety and efficacy of α-lipoic acid(ALA) in liver transplantation. The grafts were randomized to receive ALA or placebo before the cold ischemia time. Furthermore, patients transplanted with the ALA-perfused graft received 600mg of intravenous ALA, while patients with the non-perfused graft received the placebo just before graft reperfusion. Hepatic biopsy was performed 2 hours post-reperfusion. Blood samples were collected before, during and 1 and 2 days after reperfusion. qPCR analysis was performed on biopsies to assess genes involved in the response to hypoxia, apoptosis, cell growth, survival and proliferation, cytokine production and tissue damage protection. Nine of 40 patients developed post-reperfusion syndrome(PRS),
Journal of laparoendoscopic & advanced surgical techniques. Part A, Jan 16, 2018
The initial mortality rates of associating liver partition and portal vein occlusion for staged h... more The initial mortality rates of associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) were high. However, recent data from the International Registry show a continuous reduction of early mortality and major morbidity due to risk adjustment in patient selection and less invasive techniques in stage-1 surgery. During the first ALPPS International Consensus in 2015, we introduced a paradigm inversion of ALPPS, the so-called "Mini-ALPPS." We combined a partial liver partition with a novel technique of laparoscopic-assisted percutaneous cannulation of the inferior mesenteric vein for intraoperative transmesenteric portal vein embolization. We report here for the first time, a case of a successful totally laparoscopic Mini-ALPPS, and describe in detail the technical aspects of this new approach. A 61-year-old man with a 6 cm hepatocellular carcinoma compromising the right glissonian pedicle in a fibrotic liver was treated by an extended right hepate...
Introduction: Acute pancreatitis is a relatively frequent disease worldwide. Information on epide... more Introduction: Acute pancreatitis is a relatively frequent disease worldwide. Information on epidemiology and clinical outcome of the disease in Chile are scarce. Method: Data of all patients admitted in the participating hospitals from May 1-t 2014 to April 30-th 2016 were analyzed. A simple questionnaire was answered by a gastroenterologist after the patient left the hospital. Results: In 11 hospitals, 1015 patients were treated in this 2 years period, 468 males, median age 48 þ 19 years. Annual incidence was evaluated in different regions and fluctuated from 16 to 58/100.000 inhabitants. Biliary etiology was the most frequent (61%, women>men), followed by unknown origin (16%), being the alcohol consumption (men>women) only on the third place. The majority of AP was mild (MAP -74%), while moderately severe (MSAP) and severe (SAP) cases represented 13-13%. At least one CT scan or magnetic resonance image was performed in 2/3 of patients. ERCP was made in 130 and 280 cholecystectomies were performed before the hospital discharge. 41% of patients were initially admitted to more complex unit. Antibiotics were used in 351 patients. 25 patients died, mortality was 0.3% in MAP, 3% in MSAP and 14.7% in SAP. The length of hospital stay was proportional to the severity: 12.4, 17.3 and 35.2 days in the three groups, respectively. Conclusion: Epidemiology of AP was found to be comparable with international experiences. Treatment protocols were in agreement with national and international guidelines. However, hospitalization in complex units, images and antibiotics were used more than necessary.
Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual ... more Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual present as an incidental finding. The diagnosis can be made during the evaluation of chronic abdominal pain in the right lower quadrant or may emerge in the pathology report in the setting of an acute appendicitis.Appendectomy is the treatment of choice and care must be taken to avoid perforation of the appendix with dissemination of neoplastic cells or mucus into the peritoneum and thus prevent the development of pseudomyxoma peritonei.
Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual ... more Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual present as an incidental finding. The diagnosis can be made during the evaluation of chronic abdominal pain in the right lower quadrant or may emerge in the pathology report in the setting of an acute appendicitis.Appendectomy is the treatment of choice and care must be taken to avoid perforation of the appendix with dissemination of neoplastic cells or mucus into the peritoneum and thus prevent the development of pseudomyxoma peritonei.
Journal of Laparoendoscopic & Advanced Surgical Techniques, Oct 1, 2018
The initial mortality rates of associating liver partition and portal vein occlusion for staged h... more The initial mortality rates of associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) were high. However, recent data from the International Registry show a continuous reduction of early mortality and major morbidity due to risk adjustment in patient selection and less invasive techniques in stage-1 surgery. During the first ALPPS International Consensus in 2015, we introduced a paradigm inversion of ALPPS, the so-called "Mini-ALPPS." We combined a partial liver partition with a novel technique of laparoscopic-assisted percutaneous cannulation of the inferior mesenteric vein for intraoperative transmesenteric portal vein embolization. We report here for the first time, a case of a successful totally laparoscopic Mini-ALPPS, and describe in detail the technical aspects of this new approach. A 61-year-old man with a 6 cm hepatocellular carcinoma compromising the right glissonian pedicle in a fibrotic liver was treated by an extended right hepatectomy using the laparoscopic Mini-ALPPS approach. The patient had an uneventful first stage and was discharged 3 days after. A CT scan performed on postoperative day 8 showed sufficient future liver remnant volume after a 59% hypertrophy. An extended right hepatectomy was uneventfully completed and the patient was discharged 5 days after surgery. The histopathological analysis indicated advanced F4 liver fibrosis and negative tumor margins. This technical innovation allows avoiding a laparotomy to access the mesenteric venous territory and the risks of liver remnant injuries during percutaneous transhepatic approach. This new alternative may result of great utility not only in ALPPS but also for many different circumstances and scenarios.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The surgical strategy to resolve the underlying biliary pathology in patients with acute gallston... more The surgical strategy to resolve the underlying biliary pathology in patients with acute gallstone pancreatitis (AGP) remains controversial. The aim of this study was to evaluate the safety and effectiveness of early laparoscopic cholecystectomy (ELC) in patients with mild AGP. A retrospective cohort of consecutive patients diagnosed with mild AGP according to the Atlanta Guidelines from January 2009 to July 2019 was selected. Patients were assigned to surgery on the first available surgical shift, 48 h after the symptoms onset. Univariate analysis was performed to determine the association between AGP and grades of Balthazar (A, B and C) with time to surgery, days of hospitalization and postoperative complications. From 239 patients evaluated, 238 (99.58%) were operated by laparoscopic approach. Intraoperative cholangiogram was performed routinely. Choledocholithiasis, if present, was successfully treated by laparoscopic common bile duct exploration in all cases. A significant association was found between Balthazar grades and time to surgery (median of 3 days, p = 0.003), with length hospitalization and from surgery to discharge, with median of 4 days (p = 0.0001) and 2 days (p = 0.003), respectively. Mild postoperative complications (CD I/II) were observed in 22/239 patients (9.2%). This represents 2% of patients with grade A of Balthazar, 9% of grade B and 14% of grade C (p = 0.016). We observed no severe complications or mortality. ELC with routine intraoperative cholangiogram, performed on the first available surgical shift 48 h after the symptoms of pancreatitis onset, is a viable, effective and safe strategy for the resolution of mild AGP and its underlying biliary pathology in a single procedure.
LT has become the treatment of choice for children with end‐stage liver disease. The scarcity of ... more LT has become the treatment of choice for children with end‐stage liver disease. The scarcity of donors and the considerable mortality on waiting lists have propelled the related living‐donor techniques, especially in small children. This population need smaller and good quality grafts and are usually candidates to receive a LLS from a related donor. Many times this grafts are still large and do not fit in the receptor's abdomen, so a further hyper‐reduction may be required. Despite all advances in LT field, vascular complications still occur in a considerable proportion remaining as a significant cause of morbidity, graft loss, and mortality. Technical issues currently play an essential role in its genesis. The widely spread technique for biliary and vascular reconstruction in living donor LT (LDLT) nowadays implies removal of the portal vein (PV) clamp after the venous anastomosis, then the arterial reconstruction is done, followed by the biliary reconstruction. However, due t...
A double-blind randomized controlled trial was performed to compare the safety and efficacy of α-... more A double-blind randomized controlled trial was performed to compare the safety and efficacy of α-lipoic acid(ALA) in liver transplantation. The grafts were randomized to receive ALA or placebo before the cold ischemia time. Furthermore, patients transplanted with the ALA-perfused graft received 600mg of intravenous ALA, while patients with the non-perfused graft received the placebo just before graft reperfusion. Hepatic biopsy was performed 2 hours post-reperfusion. Blood samples were collected before, during and 1 and 2 days after reperfusion. qPCR analysis was performed on biopsies to assess genes involved in the response to hypoxia, apoptosis, cell growth, survival and proliferation, cytokine production and tissue damage protection. Nine of 40 patients developed post-reperfusion syndrome(PRS),
Journal of laparoendoscopic & advanced surgical techniques. Part A, Jan 16, 2018
The initial mortality rates of associating liver partition and portal vein occlusion for staged h... more The initial mortality rates of associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) were high. However, recent data from the International Registry show a continuous reduction of early mortality and major morbidity due to risk adjustment in patient selection and less invasive techniques in stage-1 surgery. During the first ALPPS International Consensus in 2015, we introduced a paradigm inversion of ALPPS, the so-called "Mini-ALPPS." We combined a partial liver partition with a novel technique of laparoscopic-assisted percutaneous cannulation of the inferior mesenteric vein for intraoperative transmesenteric portal vein embolization. We report here for the first time, a case of a successful totally laparoscopic Mini-ALPPS, and describe in detail the technical aspects of this new approach. A 61-year-old man with a 6 cm hepatocellular carcinoma compromising the right glissonian pedicle in a fibrotic liver was treated by an extended right hepate...
Introduction: Acute pancreatitis is a relatively frequent disease worldwide. Information on epide... more Introduction: Acute pancreatitis is a relatively frequent disease worldwide. Information on epidemiology and clinical outcome of the disease in Chile are scarce. Method: Data of all patients admitted in the participating hospitals from May 1-t 2014 to April 30-th 2016 were analyzed. A simple questionnaire was answered by a gastroenterologist after the patient left the hospital. Results: In 11 hospitals, 1015 patients were treated in this 2 years period, 468 males, median age 48 þ 19 years. Annual incidence was evaluated in different regions and fluctuated from 16 to 58/100.000 inhabitants. Biliary etiology was the most frequent (61%, women>men), followed by unknown origin (16%), being the alcohol consumption (men>women) only on the third place. The majority of AP was mild (MAP -74%), while moderately severe (MSAP) and severe (SAP) cases represented 13-13%. At least one CT scan or magnetic resonance image was performed in 2/3 of patients. ERCP was made in 130 and 280 cholecystectomies were performed before the hospital discharge. 41% of patients were initially admitted to more complex unit. Antibiotics were used in 351 patients. 25 patients died, mortality was 0.3% in MAP, 3% in MSAP and 14.7% in SAP. The length of hospital stay was proportional to the severity: 12.4, 17.3 and 35.2 days in the three groups, respectively. Conclusion: Epidemiology of AP was found to be comparable with international experiences. Treatment protocols were in agreement with national and international guidelines. However, hospitalization in complex units, images and antibiotics were used more than necessary.
Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual ... more Appendiceal mucinous neoplasms are rare and represent 0.2-0.7% of all appendectomies. They usual present as an incidental finding. The diagnosis can be made during the evaluation of chronic abdominal pain in the right lower quadrant or may emerge in the pathology report in the setting of an acute appendicitis.Appendectomy is the treatment of choice and care must be taken to avoid perforation of the appendix with dissemination of neoplastic cells or mucus into the peritoneum and thus prevent the development of pseudomyxoma peritonei.
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