Prospective randomized controlled trial investigating the type of sutures used during hepatectomy

AIM: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy. METHODS: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absorbable sutures (Silk) group. RESULTS: SSI was observed in 13.6% (17/125) patients participating in this study, 11.3% in the Vicryl group and 15.8% in the Silk group. Incisional SSI including superficial and deep SSI, was observed in 8% of the Vicryl group and 9.5% of the Silk group. Organ/ space SSI was observed in 3.2% of the Vicryl group and 6.0% of the Silk group. There were no significant differences, but among the patients with SSI, the period for recovery was significantly shorter for the Vicryl group compared to the Silk group.CONCLUSION: The incidence of SSI in patients receiving absorbable sutures and silk sutures is not significantly different in this randomized controlled study; however, the period for recovery in patients with SSI was significantly shorter for absorbable sutures.

Prognosis of hepatocellular carcinoma accompanied by microscopic portal vein invasion

AIM:To investigate the prognostic factors in patients with hepatocellular carcinoma(HCC) accompanied by microscopic portal vein invasion(PVI).METHODS:Of the 267 patients with HCC undergoing hepatic resection at Aso Iizuka Hospital,71 had PVI.After excluding 16 patients with HCC that invaded the main trunk and the first and second branches of the portal vein,55 patients with microscopic PVI were enrolled.RESULTS:The patients with HCC accompanied by microscopic invasion were divided into two groups:solitary PVI(PVI-S:n = 44),and multiple PVIs(PVI-M:n = 11).The number of portal vein branches invaded by tumor thrombi was 5.4 ± 3.8(2-16) in patients with PVI-M.In cumulative survival,PVI-M was found to be a significantly poor prognostic factor(P = 0.0019);while PVI-M and non-anatomical resection were significantly poor prognostic factors in disease-free survival(P = 0.0213,and 0.0115,respectively).In patients with PVI-M,multiple intrahepatic recurrence was more common than in the patients with PVI-S(P = 0.0049).In patients with PVI-S,non-anatomical resection was a significantly poor prognostic factor in disease-free survival(P = 0.0370).Operative procedure was not a significant prognostic factor in patients with PVI-M.CONCLUSION:The presence of PVI-M was a poor prognostic factor in patients with HCC,accompanied by microscopic PVI.Anatomical resection is recommended in these patients with HCC.Patients with HCC and PVI-M may also be good candidates for adjuvant chemotherapy.

Immediate detection of endoscopic retrograde cholangiopancreatographyrelated periampullary perforation: Fluoroscopy or endoscopy?

AIM:To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography(ERCP)-related perforations to support immediate or early diagnosis.METHODS:Consecutive patients who underwent ERCP procedures at our hospital between January2008 and June 2013 were retrospectively enrolled in the study(n=2674).All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation.For patients showing alterations in the gastrointestinal anatomy,a short-type double balloon enteroscope had been applied.Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitonealspace,or upon endoscopic detection of an abdominal cavity related to the perforated lumen.For patients with ERCP-related perforations,the data on medical history,endoscopic findings,radiologic findings,diagnostic methods,management,and clinical outcomes were used for descriptive analysis.RESULTS:Of the 2674 ERCP procedures performed during the 71-mo study period,only six(0.22%)resulted in perforations(male/female,2/4;median age:84 years;age range:57-97 years).The cases included an endoscope-related duodenal perforation,two periampullary perforations related to endoscopic sphincterotomy,two periampullary perforations related to endoscopic papillary balloon dilation,and a periampullary or bile duct perforation secondary to endoscopic instrument trauma.No cases of guidewire-related perforation occurred.The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation;the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively(at a median post-ERCP intervention time of 15 min).Three out of the six total perforation cases,including the single case of endoscope-related duodenal injury,were surgically treated;the remaining three cases were treated with conservative management,including trans-arterial embolization to control the bleeding in one of the cases.All patients recovered without further incident.CONCLUSION:ERCP-related perforations may be difficult to diagnose by video endoscope and digital fluoroscope detection of retroperitoneal free air or contrast medium leakage can facilitate diagnosis.