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Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery:An algorithmic approach

World Journal of Gastroenterology 2008年第19期14卷 3049-3053页

作者： Georgios Fragulidis Athanasios Marinis Andreas Polydorou Christos Konstantinidis Georgios Anastasopoulos John Contis dionysios voros Vassilios Smyrniotis Second Department of Surgery Areteion University HospitalAthens Medical SchoolUniversity of Athens

AIM:To investigate injuries of anatomy variants of hepatic duct confluence during hepatobiliary surgery and their impact on morbidity and mortality of these procedures. An algorithmic approach for the management of these injuries is proposed. METHODS:During a 6-year period 234 patients who had undergone major hepatobiliary surgery were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic and magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy and fistulography. RESULTS:Thirty (12.8%) patients who developed postoperative bile leaks were identified. Endoscopic stenting and percutaneous drainage were successful in 23 patients with bile leaks from the liver cut surface. In the rest seven patients with injuries of hepatic duct confluence, biliary variations were recognized and a stepwise therapeutic approach was considered. Conservative management was successful only in 2 patients. Volume of the liver remnant and functional liver reserve as well as local sepsis were used as criteria for either resection of the corresponding liver segment or construction of a biliary-enteric anastomosis. Two deaths occurred in this group of patients with hepatic duct confluence variants (mortality rate 28.5%). CONCLUSION:Management of major biliary fistulaethat are disconnected from the mainstream of the biliary tree and related to injury of variants of the hepatic duct confluence is extremely challenging. These patients have a grave prognosis and an early surgical procedure has to be considered.

关键词： Biliary aberrations Bile duct injury Postope-rative bile leakage Hepatic duct confluence Hepatectomy

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Surgical approaches of resectable synchronous colorectal liver metastases:Timing considerations

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World Journal of Gastroenterology 2007年第9期13卷 1431-1434页

作者： Ioannis Vassiliou Nick Arkadopoulos Theodosios Theodosopoulos Georgios Fragulidis Athanasios Marinis Agathi Kondi-Paphiti Lazaros Samanides Andreas Polydorou Constantinos Gennatas dionysios voros Vassilios Smyrniotis 2nd Department of Surgery Aretaieion HospitalUniversity of AthensSchool of Medicine AthensGreece Department of Pathology Aretaieion Hospital University of Athens School of Medicine Athens Greece Department of Oncology Aretaieion Hospital University of Athens School of Medicine AthensGreece

AIM: To compare the safety and efficacy of simultaneous versus two stage resection of primary colorectal tumors and liver metastases. METHODS: From January 1996 to May 2004, 103 colorectal tumor patients presented with synchronous liver metastases. Twenty five underwent simultaneous colorectal and liver surgery and 78 underwent liver surgery 1-3 mo after primary colorectal tumor resection. Data were retrospectively analyzed to assess and compare the morbidity and mortality between the surgical strategies. The two groups were comparable regarding the age and sex distribution, the types of liver resection and stage of primary tumors, as well as the number and size of liver metastases. RESULTS: In two-stage procedures more transfusions were required (4 ± 1.5 vs 2 ± 1.8, pRBCs, P < 0.05). Chest infection was increased after the two-stage approach (26% vs 17%, P < 0.05). The two-stage procedure was also associated with longer hospitalization (20 ± 8 vs 12 ± 6 d, P < 0.05). Five year survival in both groups was similar (28% vs 31%). No hospital mortality occurred in our series. CONCLUSION: Synchronous colorectal liver metastases can be safely treated simultaneously with the primary tumor. Liver resection should be prioritized over colon resection. It is advisable that complex liver resections with marginal liver residual volume should be dealt with at a later stage.

关键词： Synchronous colorectal liver metastases Colon resections Liver resections

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