AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the c...AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.展开更多
Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has gained interest,as the potential alternative to portal vein embolisation for inducing future liver remnant hypertrophy in patients ...Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has gained interest,as the potential alternative to portal vein embolisation for inducing future liver remnant hypertrophy in patients at risk of post-hepatectomy liver failure but is associated with high morbidity and mortality.As a result,several variant ALPPS have been reported to reduce ALPPS related morbidity and mortality.ALPPS is able to induce more extensive hypertrophy in a shorter time-period than portal vein embolisation.Minimally-invasive surgery,which has known benefits with regards to morbidity and mortality,has also been applied to ALPPS,with promising results regarding safety and feasibility and patient outcomes.Evidence suggests that both laparoscopic and robot-assisted ALPPS present technically feasible and safe options for patients.Minimally-invasive ALPPS offers a clear benefit to patients,including reduction of fibrous adhesions,shorter length of hospital stay,and lower morbidity.However,the technical difficulty of the procedure still limits its wide application,even to experienced hepato-pancreato-biliary centres.展开更多
文摘AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity. METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm. RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded. CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.
文摘Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has gained interest,as the potential alternative to portal vein embolisation for inducing future liver remnant hypertrophy in patients at risk of post-hepatectomy liver failure but is associated with high morbidity and mortality.As a result,several variant ALPPS have been reported to reduce ALPPS related morbidity and mortality.ALPPS is able to induce more extensive hypertrophy in a shorter time-period than portal vein embolisation.Minimally-invasive surgery,which has known benefits with regards to morbidity and mortality,has also been applied to ALPPS,with promising results regarding safety and feasibility and patient outcomes.Evidence suggests that both laparoscopic and robot-assisted ALPPS present technically feasible and safe options for patients.Minimally-invasive ALPPS offers a clear benefit to patients,including reduction of fibrous adhesions,shorter length of hospital stay,and lower morbidity.However,the technical difficulty of the procedure still limits its wide application,even to experienced hepato-pancreato-biliary centres.
