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Chedid MF, Brum PW, Grezzana-Filho TDJM, Silva RKD, Pereira PF, Chedid AD, Kruel CRP. PARTIAL HEPATECTOMY USING LINEAR CUTTER STAPLER: ARE THERE ADVANTAGES? Arq Bras Cir Dig 2023; 36:e1775. [PMID: 38088722 PMCID: PMC10712918 DOI: 10.1590/0102-672020230057e1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Morbidity of liver resections is related to intraoperative bleeding and postoperative biliary fistulas. The Endo-GIA stapler (EG) in liver resections is well established, but its cost is high, limiting its use. The linear cutting stapler (LCS) is a lower cost device. AIMS To report open liver resections, using LCS for transection of the liver parenchyma and en bloc stapling of vessels and bile ducts. METHODS Ten patients were included in the study. Four patients with severe abdominal pain had benign liver tumors (three adenomas and one focal nodular hyperplasia). Among the remaining six patients, four underwent liver resection for the treatment of colorectal liver metastases, three of which had undergone preoperative chemotherapy. The other two cases were one patient with metastasis from a testicular teratoma and the other with metastasis from a gastrointestinal neuroectodermal tumor. RESULTS The average length of stay was five days (range 4-7 days). Of the seven patients who underwent resections of segments II/III, two presented postoperative complications: one developed a seroma and the other a collection of abdominal fluid who underwent percutaneous drainage, antibiotic therapy, and blood transfusion. Furthermore, the three patients who underwent major resections had postoperative complications: two developed anemia and received blood transfusions and one had biloma and underwent percutaneous drainage and antibiotic therapy. CONCLUSIONS The use of the linear stapler in hepatectomies was efficient and at lower costs, making it suitable for use whenever EG is not available. The size of the LCS stapler shaft is more suitable for en bloc transection of the left lateral segment of the liver, which is thinner than the right one. Further studies are needed to evaluate the safety of LCS for large liver resections and resections of tumors located in the right hepatic lobe.
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Affiliation(s)
- Marcio Fernandes Chedid
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Pietro Waltrick Brum
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Tomaz de Jesus Maria Grezzana-Filho
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Rafaela Kathrine da Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Pedro Funari Pereira
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Aljamir Duarte Chedid
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Cleber Rosito Pinto Kruel
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
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Fernandes MR, Ghezzi CLA, Grezzana-Filho TJM, Feier FH, Leipnitz I, Chedid AD, Cerski CTS, Chedid MF, Kruel CRP. Giant hepatic extra-gastrointestinal stromal tumor treated with cytoreductive surgery and adjuvant systemic therapy: A case report and review of literature. World J Gastrointest Surg 2021; 13:315-322. [PMID: 33796218 PMCID: PMC7992998 DOI: 10.4240/wjgs.v13.i3.315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/17/2020] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary extra-gastrointestinal stromal tumors (E-GIST) of the liver are rare. The clinical presentation may range from asymptomatic to bleeding or manifestations of mass effect. Oncologic surgery followed by adjuvant therapy with imatinib is the standard of care. However, under specific circumstances, a cytoreductive approach may represent a therapeutic option. We describe herein the case of an 84-year-old woman who presented with a tender, protruding epigastric mass. Abdominal computed tomography scan revealed a large, heterogeneous mass located across segments III, IV, V, and VIII of the liver. The initial approach was transarterial embolization of the tumor, which elicited no appreciable response. Considering the large size and central location of the tumor and the advanced age of the patient, non-anatomic complete resection was indicated. Due to substantial intraoperative bleeding and hemodynamic instability, only a near-complete resection could be achieved. Histopathology and immunohistochemical staining confirmed the diagnosis of primary E-GIST of the liver. Considering the risk/benefit ratio for therapeutic options, debulking surgery may represent a strategy to control pain and prolong survival.
CASE SUMMARY Here, we present a case report of a patient diagnosed with E-GIST primary of the liver, which was indicated a cytoreductive surgery and adjuvant therapy with imatinib.
CONCLUSION E-GIST primary of the liver is a rare conditional, the treatment is with systemic therapy and total resection surgery. However, a cytoreductive surgery will be necessary when a complete resection is no possible.
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Affiliation(s)
- Michel Ribeiro Fernandes
- Department of Gastrointestinal Surgery and Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, RS, Brazil
| | | | - Tomaz JM Grezzana-Filho
- Department of Gastrointestinal Surgery and Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, RS, Brazil
| | - Flávia Heinz Feier
- Department of Gastrointestinal Surgery and Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, RS, Brazil
| | - Ian Leipnitz
- Department of Gastrointestinal Surgery and Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, RS, Brazil
| | - Aljamir Duarte Chedid
- Department of Gastrointestinal Surgery and Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, RS, Brazil
| | | | - Marcio Fernandes Chedid
- Department of Gastrointestinal Surgery and Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, RS, Brazil
| | - Cléber Rosito Pinto Kruel
- Department of Gastrointestinal Surgery and Transplantation, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, RS, Brazil
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Piltcher-da-Silva R, Chedid MF, Grezzana Filho TJM, Leipnitz I, de Araújo A, Gazzana MB, Saueressig MG, Lorenzi W, Cardoni MG, Bellaver P, Alvares-da-Silva MR, Feier FH, Chedid AD, Kruel CRP. Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant: Recovery after 67 days of ECMO support. Int J Artif Organs 2021; 45:121-123. [PMID: 33478326 DOI: 10.1177/0391398821989067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative morbidity and mortality. There is no effective treatment for patients whose hypoxemia does not respond to LT. This subset of patients is at a highly increased risk of death. There are very few reports on the use of extracorporeal membrane oxygenation (ECMO) in this setting with rapid response. However, there is no prior report of ECMO utilization for longer than 4 weeks. We present the case of a 17 year-old male patient who underwent LT for ESLD secondary to chronic portal vein thrombosis and HPS. He received a liver from a deceased donor and presented with severe HPS after LT, requiring ECMO support for 67 days. The patient was discharged home and is breathing in ambient air. He is currently asymptomatic and has a normal liver function.
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Affiliation(s)
| | | | | | - Ian Leipnitz
- Liver transplantation, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre de Araújo
- Liver transplantation, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | | | | | - Priscila Bellaver
- Liver transplantation, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Flavia Heinz Feier
- Liver transplantation, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Chedid MF, Bosi HR, Chedid AD, Alvares-da-Silva MR, Leipnitz I, Grezzana-Filho TJM, Reis MJ, Filho GM, Ghissi AJ, Neto PR, de Araujo A, Arruda S, Lopes AB, Michalczuk MT, Backes AN, Kruel CDP, Kruel CRP. One Hundred Consecutive Liver Transplants Using Institutes Georges Lopez-1 Preservation Solution: Outcomes and Prognostic Factors. Transplant Proc 2017; 49:848-851. [PMID: 28457409 DOI: 10.1016/j.transproceed.2017.01.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are only 4 prior studies reporting on outcomes of liver transplantation (LT) using Institutes Georges Lopez-1 (IGL-1) preservation solution. Detection of negative predictors of LT using IGL-1 may help finding strategies to protect selected recipients at higher risk of graft failure and death. METHODS Review of all consecutive adult patients who underwent a first whole-graft LT using IGL-1 at authors' institution from 2013 to 2016. Primary end point was graft failure within the first 90 postoperative days (PODs). Graft losses due to any cause (including all deaths with a functioning graft) were recorded as graft failures. RESULTS Of all 100 patients included in this study, 37 were women; median age was 58 years (range 18-71). There were 12 graft losses during the first 90 PODs (including 3 cases of primary nonfunction of the liver allograft), and 10 of the 12 graft losses occurred on first 30 PODs. All 12 patients who experienced graft loss (including 1 patient who underwent liver retransplantation) died within the first 90 PODs. Of the total 100 patients, 14 experienced biliary complications. Univariate analysis revealed prolonged warm ischemic time (WIT) as the only predictor of 90-day graft failure (odds ratio = 23.5, confidence interval = 1.29-430.18, P = .03). The cutoff by receiver operating characteristic curve for WIT was 38 minutes (area under the curve = 0.70). Positive predictive value for WIT >38 minutes was 94.3%. CONCLUSIONS LT using IGL-1 can be performed safely. Similar to prior reports on LT using other preservation solutions, prolonged WIT was associated with adverse outcomes.
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Affiliation(s)
- M F Chedid
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - H R Bosi
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A D Chedid
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M R Alvares-da-Silva
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - I Leipnitz
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - T J M Grezzana-Filho
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M J Reis
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - G M Filho
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A J Ghissi
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - P R Neto
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A de Araujo
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - S Arruda
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A B Lopes
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M T Michalczuk
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A N Backes
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - C D P Kruel
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - C R P Kruel
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Kruel CRP, Guimarães M, Chedid AD, Grezzana-Filho TMDJ, Leipnitz I, Araújo AD, Alvares-da-Silva MR, Kruel CDP. Bilhemia following transjugular intrahepatic portosystemic shunt placement (Tips): liver transplantation as a rescue procedure - case report. Arq Bras Cir Dig 2014; 26:238-40. [PMID: 24190385 DOI: 10.1590/s0102-67202013000300016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Chedid AD, Domingues LA, Chedid MF, Villwock MDM, Mondelo AR. [Solitary diverticulum of the cecum: experience of a Brazilian general hospital]. Arq Gastroenterol 2004; 40:216-9. [PMID: 15264042 DOI: 10.1590/s0004-28032003000400004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cecal diverticulitis is a rare condition, specially in western people. Its importance concerns of being part of the differential diagnosis of acute appendicitis and ulcerated cecal carcinoma. AIM To present the experience of southern Brazilian general hospital in the treatment of cecal diverticulitis. MATERIAL AND METHODS We present four cases of single inflamed cecal diverticulum. One was diagnosed by pre-operatively computer tomography and was treated medically without complications. The other three cases were diagnosed during operation and treated by right hemicolectomy and ileotransverse anastomosis. RESULTS There were no deaths or complications. When cecal diverticulitis is pre-operatively diagnosed it may be treated medically. We preclude laparotomy when the diagnosis is uncertain. CONCLUSION We recommend radical surgical management when the diagnosis is made during operation.
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Abstract
A 71-year-old man with presumptively treated pulmonary tuberculosis ten years earlier and previous alcoholism presented with adrenal insufficiency. HIV serology was negative. A computerized tomography scan of the abdomen showed enlarged right adrenal. He recovered after emergency treatment with hydrocortisone IV. Right adrenalectomy was performed. Histoplasmosis was diagnosed and the patient was treated with itraconazole, corticosteroid replacement, and discharged with good health.
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Affiliation(s)
- Marcio Fernandes Chedid
- Serviço de Transplante Hepático Adulto, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Abstract
OBJETIVO: Determinar o impacto de fatores prognósticos na sobrevida de pacientes com metástases hepáticas ressecadas e originadas de câncer colorretal. CASUÍSTICA E MÉTODOS: Foram analisados os prontuários de 28 pacientes submetidos a ressecção hepática de metástases de câncer colorretal de abril de 1992 a setembro de 2001. Foram realizadas 38 ressecções (8 pacientes com mais de uma ressecção no mesmo tempo cirúrgico e 2 pacientes submetidos a re-ressecções). Todos haviam sido submetidos previamente a ressecção do tumor primário. Utilizou-se protocolo de rastreamento de metástases hepáticas que incluiu revisões clínicas trimestrais, ecografia abdominal e dosagem de CEA até se completarem 5 anos de seguimento e após, semestralmente. Os fatores prognósticos estudados foram: estágio do tumor primário, tamanho das metástases > 5cm, intervalo entre ressecção do tumor primário e surgimento da metástase < 1 ano, CEA >100 ng/mL, margens cirúrgicas < 1cm e doença metastática extra-hepática. O estudo foi retrospectivo e a análise estatística foi feita pela curva de Kaplan-Meier, log-rank e regressão de Cox. RESULTADOS: A morbidade foi 39,3% e a mortalidade operatória foi 3,6%. A sobrevida em 5 anos foi de 35%. Os fatores prognósticos independentes adversos foram: intervalo < 1 ano entre ressecção do tumor primário e surgimento da metástase, e doença metastática extra-hepática. CONCLUSÕES: A ressecção hepática de metástases de câncer colorretal é um procedimento seguro com sobrevida em 5 anos acima dos 30%. Foram fatores prognósticos independentes adversos: doença metastática extra-hepática e intervalo < 1 ano entre ressecção do tumor primário e surgimento da metástase.
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Chedid AD, Klein PW, Tiburi MF, Villwock MM, Bassani LE, Chedid MF. Spontaneous rupture of hepatocellular carcinoma with haemoperitoneum: a rare condition in Western countries. HPB (Oxford) 2001; 3:227-30. [PMID: 18333020 PMCID: PMC2020622 DOI: 10.1080/136518201753242262] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Haemoperitoneum secondary to non-traumatic liver rupture is a rare but potentially fatal condition. It may result from several neoplastic and non-neoplastic diseases such as primary benign or malignant tumours, peliosis hepatis, polyarteritis nodosa, systemic lupus erythematosus, pre-eclampsia and metastatic carcinoma. CASE OUTLINES Three cases of spontaneous haemoperitoneum caused by rupture of hepatocellular carcinoma are described. All three patients (two men, one woman) had cirrhotic livers, and all were submitted to an urgent operation.One patient re-bled on a second occasion. Emergency operation was undertaken four times in three patients and was successful on all but one occasion. DISCUSSION The prognosis for patients with haemoperitoneum is generally poor. Although this condition is relatively frequent in some regions of Asia and Africa, it has rarely been reported in Western countries.The present experience shows that emergency laparotomy can be life-saving.
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Affiliation(s)
- AD Chedid
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - PW Klein
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - MF Tiburi
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - MM Villwock
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - LE Bassani
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - MF Chedid
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
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Chedid AD, Klein PW, Tiburi MF, Bassani LE, Villwock MM, Chedid MF. Papillary cystic neoplasm of the pancreas. HPB (Oxford) 2001; 3:281-4. [PMID: 18333033 PMCID: PMC2020638 DOI: 10.1080/136518201753335700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Papillary cystic neoplasm of the pancreas is a rare disorder that occurs most commonly in young women. It has a low potential for malignancy, and the prognosis following resection is favourable. CASE OUTLINE An 18-year-old white girl presented with a palpable mass in the right hypochondrium on physical examination associated with epigastric pain, nausea and vomiting, but no fever. Upper gastro-intestinal endoscopy revealed extrinsic compression of the posterior wall of the antrum and duodenal bulb with no mucosal lesion. Computed tomography (CT) scan and then laparotomy revealed a large tumour adjacent to the hepatic hilum and originating from the head of pancreas. Pancreatoduodenectomy was performed, and a diagnosis of papillary cystic neoplasm of the pancreas was made.There was no evidence of recurrence after 6 years of follow-up. DISCUSSION A radical surgical approach is justified for papillary cystic neoplasm of the pancreas because of its biological behaviour, local aggressiveness and low incidence of metastases.
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Affiliation(s)
- A D Chedid
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - P W Klein
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - M F Tiburi
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - L E Bassani
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - M M Villwock
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
| | - M F Chedid
- Surgery Service, Hospital Ernesto DornellesPorto AlegreBrazil
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