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Hepatic vein reconstruction during hepatectomy:A feasible and underused technique

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 421-427页

作者： Manish Ahuja Kunal Joshi Chris Coldham Paulo Muiesan Bobby Dasari Manuel Abradelo Ravi Marudanayagam Darius Mirza John Isaac David Bartlett Nikolaos A Chatzizacharias Robert P Sutcliffe Keith J Roberts Department of HPB and Liver Transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Immunology and Immunotherapy University of BirminghamBirminghamUK

Complete surgical resection(R0)of liver tumors,primary or metastatic,remains the main objective in management of primary and metastatic liver tumors[1].Tumors invading to the proximity of the hepatic venous outflow pose a peculiar challenge to achieve R0 resections,because this location may render a tumor *** median survival of patients with liver tumor without surgery is less than 12 months[2].Even with surgery,post-hepatectomy liver failure and subsequently increased mortality are the main problems associated with complex resection[3].Moreover,when the vein is affected,vein resection and subsequent reconstruction are *** resection is a standard practice in liver resection and transplantation[4],for example,hepatic vein reconstruction during a living-donor liver transplant,porto-mesenteric axis reconstruction during resection of advanced pancreatic cancer and caval reconstruction during resection of retroperitoneal ***,novel techniques like total hepatic vascular exclusion(HVE)[5],veno-venous bypass[6]and ex vivo hepatic resection[7,8]have facilitated curative resections of tumors close to one or more major hepatic veins.

关键词： hepatectomy surgery mortality

Primary sclerosing cholangitis and cholangiocarcinoma:the 2023 practice guidance and future perspectives

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Hepatobiliary Surgery and Nutrition 2024年第1期13卷 172-175页

作者： Francesca Saffioti Vasileios K.Mavroeidis Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxfordUK UCL Institute for Liver and Digestive Health University College LondonLondonUK Department of HPB Surgery University Hospitals Bristol&Weston NHS Foundation TrustBristol Royal InfirmaryBristolUK Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristolUK

The 2023 practice guidance on primary sclerosing cholangitis(PSC)and cholangiocarcinoma(CCA)of the American Association for the Study of Liver Diseases(AASLD)came as a needful update to the previous 2010 guidelines on PSC,with a first-time inclusion of dedicated guidance on the diagnosis and management of CCA(1,2).This data-supported approach developed by consensus of an expert panel,provides guidance statements based on analytical review of the relevant literature.

关键词： American Association for the Study of Liver Diseases(AASLD) guidelines primary sclerosing cholangitis(PSC) liver cancer biliary cancer

Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

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Stroke & Vascular Neurology 2024年第3期9卷 279-288,I0247页

作者： Adam Ingleton Marko Raseta Rui-En Chung Kevin Jun Hui Kow Jake Weddell Sanjeev Nayak Changez Jadun Zafar Hashim Noman Qayyum Phillip Ferdinand Indira Natarajan Christine Roffe Neurosciences University Hospitals of North Midlands NHS TrustStoke-on TrentUK Statistics and Mathematical Modelling Department of Molecular GeneticsErasmus Medical CenterRotterdamZuid-HollandThe Netherlands Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK School of Medicine Keele UniversityKeeleUK Interventional Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK Stroke Research Keele UniversityKeeleUK

Background Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy(MT).Most patients undergoing MT are also given *** agents are contraindicated within 24 hours of *** evaluated outcomes and complications of patients stented with and without intravenous aspirin during *** All patients who underwent emergent extracranial stenting during MT at the Royal Stoke University Hospital,UK between 2010 and 2020,were *** were thrombolysed before MT,unless *** 500 mg intravenously was given intraoperatively at the discretion of the *** intracranial haemorrhage(sICH)and the National Institutes for Health Stroke Scale score(NIHSS)were recorded at 7 days,and mortality and functional recovery(modified Rankin Scale:mRS≤2)at 90 *** Out of 565 patients treated by MT 102 patients(median age 67 IQR 57–72 years,baseline median NIHSS 18 IQR 13–23,76(75%)thrombolysed)had a stent *** these 49(48%)were given aspirin and 53(52%)were *** treated with aspirin had greater NIHSS improvement(median 8 IQR 1–16 vs median 3 IQR-9–8 points,p=0.003),but there were no significant differences in sICH(2/49(4%)vs 9/53(17%)),mRS≤2(25/49(51%)vs 19/53(36%))and mortality(10/49(20%)vs 12/53(23%))with and without *** improvement(median 12 IQR 4–18 vs median 7 IQR-7–10,p=0.01)was greater,and mortality was lower(4/33(12%)vs 6/15(40%),p=0.05)when aspirin was combined with thrombolysis,than for aspirin alone,with no increase in *** Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes,even when combined with intravenous thrombolysis.

关键词： patients aspirin intravenous

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

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World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic *** 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and *** preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative *** incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe *** involvement of a specialist diabetes team is essential to ensure a holistic *** the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve *** various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required *** need for perioperative support of diabetic

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

Tendoscopic Surgery for Peroneal Tendons Instability: A Literature Review

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Open Journal of Orthopedics 2024年第3期14卷 139-148页

作者： Islam Mubark Amr Abouelela Mahmoud Elbakry Tarek El Gamal Department of Trauma and Orthopaedics University Hospitals Birmingham NHS Foundation Trust Birmingham UK Department of Trauma and Orthopaedics Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK Department of Trauma and Orthopaedics University Hospitals of Derby and Burton NHS Foundation Trust Derby UK

Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.

关键词： Peroneal Tendons Instability Tendoscopy

Current concepts in the management of non-cirrhotic non-malignant portal vein thrombosis

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World Journal of Hepatology 2024年第5期16卷 751-765页

作者： Adam J Willington Dhiraj Tripathi Department of Hepatology University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of Hepatology University Hospitals BirminghamBirmingham B152THUnited Kingdom

Non-cirrhotic non-malignant portal vein thrombosis(NCPVT)is an uncommon condition characterised by thrombosis of the portal vein,with or without extension into other mesenteric veins,in the absence of cirrhosis or intra-abdominal *** can include intestinal infarction,variceal bleeding and portal *** this article,we address current concepts in the management of NCPVT including identification of risk factors,classification and treatment,and review the latest evidence on medical and interventional management options.

关键词： Non-cirrhotic portal vein thrombosis Portal vein Mesenteric veins Venous thrombosis Portal hypertension

Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational Gastroenterology and Liver Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic *** disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary *** the last century,owing to migration,its global incidence has *** main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic *** classifications have aimed at providing useful insight of clinically relevant aspects and guidance for *** management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious *** comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

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World Journal of Stem Cells 2024年第4期16卷 324-333页

作者： Ilias E Epanomeritakis Wasim S Khan Division of Trauma and Orthopaedic Surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom Division of Trauma and Orthopaedic Surgery Department of SurgeryUniversity of CambridgeCambridge CB20QQUnited Kingdom

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying *** treatment ultimately requires joint *** capable of regenerating cartilage could significantly reduce financial and clinical *** regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee *** has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to ***-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative *** vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,*** avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of *** this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee *** discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative *** underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

关键词： Knee osteoarthritis Mesenchymal stromal cells Adipose tissue Stromal vascular fraction Micro-fragmented adipose tissue Regeneration

Navigating reflux disease after achalasia treatments:Balancing risks and benefits

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World Journal of Gastroenterology 2024年第21期30卷 2740-2743页

作者： Ewen A Griffiths Enoch Wong Department of Upper Gastrointestinal Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWWest MidlandsUnited Kingdom Department of Immunology and Immunotherapy University of BirminghamBirmingham B152TTWest MidlandsUnited Kingdom

The peroral endoscopic myotomy(POEM)procedure has revolutionized the management of achalasia in many centres around the world as it offers patients a minimally invasive endoscopic solution to their dysphagia caused by *** its success in alleviating dysphagia,concerns regarding postoperative gastroesophageal reflux disease have emerged as a pertinent issue which are not fully *** this study,Nabi et al have comprehensively reviewed the topic of the prediction,prevention and management of gastroesophageal reflux after *** is a purely endoscopic procedure which is usually performed without any anti-reflux *** patients may be better served by a laparoscopic Heller’s myotomy and fundoplication and it is important that gastroenterologists and surgeons provide comprehensive risks and benefits of each achalasia treatment option so that patients can decide what treatment is best for *** article by Nabi et al provides a comprehensive review of the current status of this issue to allow these discussions to occur.

关键词： Achalasia Gastro-esophageal reflux disease Laparoscopic heller’s myotomy Peroral endoscopic myotomy Fundoplication