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Menon J, Shanmugam N, Vij M, Veerankutty FH, Rammohan A, Rela M. Simultaneous total internal biliary diversion during liver transplantation for progressive familial intrahepatic cholestasis type 1: Standard of care? Liver Transpl 2024:01445473-990000000-00334. [PMID: 38353595 DOI: 10.1097/lvt.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/04/2024] [Indexed: 03/17/2024]
Abstract
Patients post liver transplant (LT) with progressive familial intrahepatic cholestasis type 1 (PFIC-1) often develop progressive graft steatohepatitis, intractable diarrhea, and growth failure. A total internal biliary diversion (TIBD) during an LT may prevent or reverse these adverse events. Children with PFIC-1 who underwent an LT at our institute were divided into 2 groups, A and B based on the timeline where we started offering a TIBD in association with LT. Pre-LT parameters, intraoperative details, and posttransplant complications like graft steatosis and diarrhea were also analyzed between the 2 groups, and their growth velocity was measured in the follow-up period. Of 550 pediatric LT performed between 2011 and 2022, 13 children underwent LT for PFIC-1. Group A had 7 patients (A1-A7) and group B had 6 (B1-B6). Patients A1, A4, B4, and B5 had a failed partial internal biliary diversion before offering them an LT. Patients A1, A2, and A6 in group A died in the post-LT period (2 early allograft dysfunction and 1 posttransplant lymphoproliferative disorder) whereas A3, A4, and A5 had graft steatosis in the follow-up period. A4 was offered a TIBD 4 years after LT following which the graft steatosis fully resolved. In group B, B1, B2, B5, and B6 underwent TIBD during LT, and B3 and B4 had it 24 and 5 months subsequently for intractable diarrhea and graft steatosis. None of the patients in group B demonstrated graft steatosis or diarrhea and had good growth catch-up during follow-up. We demonstrate that simultaneous TIBD in patients undergoing LT should be a standard practice as it helps dramatically improve outcomes in PFIC-1 as it prevents graft steatosis and/or fibrosis, diarrhea, and improves growth catch-up.
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Affiliation(s)
- Jagadeesh Menon
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Naresh Shanmugam
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Mukul Vij
- Department of Histopathology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Fadl H Veerankutty
- Department of Hepatobiliary Surgery & Liver Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ashwin Rammohan
- Department of Hepatobiliary Surgery & Liver Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Department of Hepatobiliary Surgery & Liver Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Vij M, Veerankutty FH, Raju LP, Gowrishankar G, Rajalingam R, Jothimani D, Kaliamoorthy I, Rammohan A, Rela M. Frequent expression of PD-L1 in lymphocyte-rich hepatocellular carcinoma: A report of 4 cases. Ann Diagn Pathol 2023; 66:152172. [PMID: 37348413 DOI: 10.1016/j.anndiagpath.2023.152172] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Programmed death ligand 1 (PD-L1) is an immune checkpoint inhibitor. PD-L1 binds to its receptor programmed death receptor (PD-1) expressed by immune cells and plays a key role in regulating immune responses. Engagement of PD-L1 on cancer cells and PD-1 on immune cells avoid destruction of tumour cells by immune cells. Immunostaining with PD-L1 has been suggested as a biomarker predictive of antiPD-L1 immunotherapy. Lymphocyte-rich hepatocellular carcinoma (LrHCC) is a rare histological HCC subtype which is characterised by neoplastic epithelial cells intermixed with numerous immune cells. METHODS Here in we investigated immunohistochemical PD-L1 expression in 4 cases of LrHCC. Tumour proportion score (TPS) and immune cell score was recorded. Immunophenotypic characterization of the tumour and inflammatory cells was also done. Epstein-Barr encoding region (EBER) in situ hybridization (ISH) assay as performed in all four tumours. RESULTS Expression of PD-L1 was demonstrated in tumour epithelial cells and immune cells in all four cases. Incomplete to membranous staining was demonstrated in the tumour cells. Tumour proportion score (TPS) was 1.2-20 %. Immune cells demonstrated membranous and cytoplasmic immunostaining. Immune cell score was ≥1 % to >10 %. CONCLUSION PD-L1 expression in both tumour and immune cells suggests distinct immunogenic feature and potential role of antiPD-L1 therapies in cases with inoperable disease.
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Affiliation(s)
- Mukul Vij
- Department of Pathology, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India.
| | - Fadl H Veerankutty
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India
| | - Lexmi Priya Raju
- Department of Pathology, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India
| | - Gowripriya Gowrishankar
- Department of Pathology, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India.
| | - Rajesh Rajalingam
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India
| | - Dinesh Jothimani
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India.
| | - Ilankumaran Kaliamoorthy
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India.
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr.Rela Institute & Medical Centre, No. 7 CLC Works Road Chromepet, Chennai 44, Tamil Nadu, India.
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Veerankutty FH, Sengupta K, Vij M, Rammohan A, Jothimani D, Murali A, Rela M. Post-COVID-19 cholangiopathy: Current understanding and management options. World J Gastrointest Surg 2023; 15:788-798. [PMID: 37342848 PMCID: PMC10277943 DOI: 10.4240/wjgs.v15.i5.788] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/10/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
Post-coronavirus disease 2019 (COVID-19) cholangiopathy (PCC) is a rare but life-threatening complication of COVID-19 infection. PCC typically presents when patients recovering from the contagion and manifests as cholestasis in patients with no history of pre-existing liver disease. The pathogenesis of PCC is little understood. Hepatic injury in PCC could be mediated by the predilection of severe acute respiratory syndrome coronavirus 2 for cholangiocytes. Though PCC shows some resemblance to secondary sclerosing cholangitis in critically ill patients, it is considered as a separate and unique entity in the literature. Various treatment options like ursodeoxycholic acid, steroids, plasmapheresis, and endoscopic retrograde cholangiopancreatography guided interventions have been tried but with limited success. We have noticed significant improvement in liver function with antiplatelet therapy in a couple of patients. PCC can progress to end-stage liver disease necessitating liver transplantation. In this article, we discuss the current knowledge of PCC focusing on its pathophysiology, clinical manifestations, and management strategies.
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Affiliation(s)
- Fadl H Veerankutty
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Research Centre, Chennai 600044, India
| | - Kushan Sengupta
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
| | - Mukul Vij
- Department of Pathology, Institute of Liver Disease and Transplantation, Chennai 600044, India
| | - Ashwin Rammohan
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
| | - Dinesh Jothimani
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
| | | | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai 600044, India
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Rela M, Rajakannu M, Veerankutty FH, Vij M, Rammohan A. First report of auxiliary liver transplantation for severe cholangiopathy after SARS-CoV-2 respiratory infection. Am J Transplant 2022; 22:3143-3145. [PMID: 35929565 PMCID: PMC9538267 DOI: 10.1111/ajt.17165] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 01/25/2023]
Abstract
Post-coronavirus disease 2019 (COVID-19) cholangiopathy (PCC) is a new entity observed in patients recovering from severe COVID-19 pneumonia. Most patients recover with cholestasis improving over a period of time. In some patients, cholestasis is severe and persists or progresses to liver failure necessitating liver transplant. We present a previously healthy 50-year-old man who developed PCC with peak total bilirubin of 42.4 mg/dl and did not improve with medical management. He underwent living donor auxiliary right lobe liver transplantation. He recovered well after transplant and remains asymptomatic at 6 months follow-up with good graft function and recovering function in native liver remnant.
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Affiliation(s)
- Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India,Correspondence Mohamed Rela, Dr. Rela Institute and Medical Centre, No.7, CLC Works Road, Chromepet, Chennai 600044, India.
| | - Muthukumarassamy Rajakannu
- The Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Fadl H. Veerankutty
- The Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Mukul Vij
- The Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
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Veerankutty FH, Subramanian N, Yadav A. The application of Blower-Mister in living donor liver transplantation. Int J Surg 2022. [DOI: 10.1016/j.ijsu.2022.106455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Veerankutty FH, Jayan G, Yadav MK, Manoj KS, Yadav A, Nair SRS, Shabeerali TU, Yeldho V, Sasidharan M, Rather SA. Artificial Intelligence in hepatology, liver surgery and transplantation: Emerging applications and frontiers of research. World J Hepatol 2021; 13:1977-1990. [PMID: 35070002 PMCID: PMC8727218 DOI: 10.4254/wjh.v13.i12.1977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/16/2021] [Revised: 05/09/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The integration of artificial intelligence (AI) and augmented realities into the medical field is being attempted by various researchers across the globe. As a matter of fact, most of the advanced technologies utilized by medical providers today have been borrowed and extrapolated from other industries. The introduction of AI into the field of hepatology and liver surgery is relatively a recent phenomenon. The purpose of this narrative review is to highlight the different AI concepts which are currently being tried to improve the care of patients with liver diseases. We end with summarizing emerging trends and major challenges in the future development of AI in hepatology and liver surgery.
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Affiliation(s)
- Fadl H Veerankutty
- Comprehensive Liver Care, VPS Lakeshore Hospital, Cochin 682040, Kerala, India
| | - Govind Jayan
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Manish Kumar Yadav
- Department of Radiodiagnosis, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Krishnan Sarojam Manoj
- Department of Radiodiagnosis, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Abhishek Yadav
- Comprehensive Liver Care, VPS Lakeshore Hospital, Cochin 682040, Kerala, India
| | - Sindhu Radha Sadasivan Nair
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - T U Shabeerali
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Varghese Yeldho
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Madhu Sasidharan
- Gastroenterology and Hepatology, Kerala Institute of Medical Sciences, Thiruvananthapuram 695029, India
| | - Shiraz Ahmad Rather
- Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
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Veerankutty FH, Subrahmanya P, Chacko S, Sreekumar VI, Kamalesh NP, Kurumboor P. Laparoscopic low anterior resection for rectal bleeding in Klippel-Trénaunay syndrome - a video vignette. Colorectal Dis 2020; 22:350-351. [PMID: 31648406 DOI: 10.1111/codi.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/08/2019] [Indexed: 02/08/2023]
Affiliation(s)
- F H Veerankutty
- Department of GI and HPB Surgery, Aster Medcity, Cochin, India
| | - P Subrahmanya
- Department of GI and HPB Surgery, Aster Medcity, Cochin, India
| | - S Chacko
- Department of GI and HPB Surgery, Aster Medcity, Cochin, India
| | - V I Sreekumar
- Department of GI and HPB Surgery, Aster Medcity, Cochin, India
| | - N P Kamalesh
- Department of GI and HPB Surgery, Aster Medcity, Cochin, India
| | - P Kurumboor
- Department of GI and HPB Surgery, Aster Medcity, Cochin, India
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Veerankutty FH, Nair N, Chacko S, Sreekumar VI, Varma D, Kurumboor P. Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective. J Minim Access Surg 2020; 16:251-255. [PMID: 31793449 PMCID: PMC7440015 DOI: 10.4103/jmas.jmas_272_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Laparoscopic resection for rectal cancer (LRR) has gained popularity because of better short-term outcomes and less post-operative morbidity. However, LRR is still not endorsed as a standard of care mainly due to concerns centred on oncological safety in comparison with open approach. Moreover, two recent randomised trials (Australian Laparoscopic Cancer of the Rectum [ALaCaRT] and the American College of Surgeons Oncology Group [ACOSOG] Z6051) have failed to prove that LRR is non-inferior to open resection. Studies on oncological adequacy of LRR in the Indian population in terms of quality of mesorectal excision are scarce. In this article, we aim to audit the oncological adequacy of LRR in our centre and thereby critically analyse the reliability of extrapolation of results of ALaCaRT and ACOSOG trials to the Indian population. Methods: We retrospectively analysed the oncological adequacy of LRR in terms of completeness of total mesorectal excision (TME), distal and circumferential resection margin (CRM) status and nodal harvest in patients with rectal cancer who underwent LRR between January 2016 and June 2018 at our centre. Results: Of 157 patients included in this study, a complete TME was achieved in 148 (94.26%) patients and nearly complete in 7 (4.46%) patients. A safe CRM (≥1 mm) was obtained in 151 (96.18%) patients. Distal margin results were negative in 155 (98.73%) patients. Average nodal harvest was 19.86 ± 9.28. Overall surgical success, calculated as a composite measure of negative distal margin and negative CRM and complete TME was 95.54%. Conclusion: Good quality rectal cancer resection can be achieved by experienced laparoscopic surgeons without compromising oncological safety.
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Affiliation(s)
| | - Nandu Nair
- Department of GI and HPB Surgery, Aster Medcity, Cochin, Kerala, India
| | - Sidharth Chacko
- Department of GI and HPB Surgery, Aster Medcity, Cochin, Kerala, India
| | - Vipin I Sreekumar
- Department of GI and HPB Surgery, Aster Medcity, Cochin, Kerala, India
| | - Deepak Varma
- Department of GI and HPB Surgery, Aster Medcity, Cochin, Kerala, India
| | - Prakash Kurumboor
- Department of GI and HPB Surgery, Aster Medcity, Cochin, Kerala, India
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Veerankutty FH, Rather SA, Yeldho V, Zacharia BM, Tu SA, B V. Totally Laparoscopic Resection of an Extremely Giant Hepatic Hemangioma. Surg J (N Y) 2019; 5:e110-e112. [PMID: 31548991 PMCID: PMC6754746 DOI: 10.1055/s-0039-1698520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 06/17/2019] [Indexed: 01/22/2023] Open
Abstract
Risk of massive intraoperative hemorrhage and the difficulty to control it makes the laparoscopic treatment of giant hepatic hemangiomas (GH) a challenge for minimally invasive hepatobiliary surgeons. Symptomatic GHs of more than 20 cm (extremely giant hepatic hemangiomas) are typically treated with an open resection. There is a paucity of literature on laparoscopic resection of extremely giant hepatic hemangiomas. We describe (with video), here, the technical nuances of pure laparoscopic resection of an extremely giant hepatic hemangioma using modified port positions and the anterior approach.
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Affiliation(s)
- Fadl H Veerankutty
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Shiraz Ahmad Rather
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Varghese Yeldho
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Bincy M Zacharia
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Shabeer Ali Tu
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Venugopal B
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
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Veerankutty FH, Chacko S, Sreekumar VI, Krishnan P, Varma D, Kurumboor P. Exploring minimally invasive options: Laparoscopic transabdominal levator transection for low rectal cancers. J Minim Access Surg 2018; 15:174-176. [PMID: 30106021 PMCID: PMC6438078 DOI: 10.4103/jmas.jmas_130_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extralevator abdominoperineal excision (ELAPE) of the rectum offers wider circumferential margin and decreased rate of intraoperative tumour perforation. However, the need to change the position of the patient in between abdominal and perineal stages of the procedure and extended perineal resection result in increased morbidity and operative time. Evolving technique of laparoscopic transabdominal controlled division of levator ani muscles under direct vision could address these issues while providing all benefits of ELAPE for patients with low rectal cancers.
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Affiliation(s)
| | - Sidharth Chacko
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - Vipin I Sreekumar
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - Prasad Krishnan
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - Deepak Varma
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
| | - Prakash Kurumboor
- Department of GI and HPB Surgery, Aster Medcity, Kochi, Kerala, India
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Veerankutty FH, Saleem S, Chacko S, Sreekumar VI, Krishnan P, Varma D, Kurumboor P. IgG4-Related Disease of the Appendix. J Gastrointest Surg 2018; 22:1124-1126. [PMID: 29188490 DOI: 10.1007/s11605-017-3636-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/07/2017] [Indexed: 01/31/2023]
Affiliation(s)
| | - Suhail Saleem
- Department of Pathology, Aster Medcity, Cochin, 682027, India
| | - Sidharth Chacko
- Department of GI and HPB Surgery, Aster Medcity, Cochin, 682027, India
| | - Vipin I Sreekumar
- Department of GI and HPB Surgery, Aster Medcity, Cochin, 682027, India
| | - Prasad Krishnan
- Department of GI and HPB Surgery, Aster Medcity, Cochin, 682027, India
| | - Deepak Varma
- Department of GI and HPB Surgery, Aster Medcity, Cochin, 682027, India
| | - Prakash Kurumboor
- Department of GI and HPB Surgery, Aster Medcity, Cochin, 682027, India
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Veerankutty FH, Ali TUS, Manoj KS, Venugopal B. Reconstruction of a rare variant of the left hepatic vein in a left lateral segment liver graft from a living donor: Technical notes. J Indian Assoc Pediatr Surg 2016; 21:41-3. [PMID: 26862296 PMCID: PMC4721129 DOI: 10.4103/0971-9261.171938] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Reconstruction of hepatic veins in living donor liver transplantation (LDLT) is often technically challenging and a good venous outflow is essential for survival of the graft and patient. We describe a quadrangular patch venoplasty technique used for the reconstruction of a rare variant of the left hepatic vein (LHV) in a pediatric LDLT with left lateral segment (LLS) graft. Segment II vein in the graft was draining directly into the inferior vena cava (IVC) and segment III vein was draining into the middle hepatic vein (MHV) after receiving a tributary from segment IV so that there were two widely separated ostia at the cut surface. This is one of the rarest variations of the LHV and is so called type 3 variant; it is usually reconstructed using interposition tubular conduits necessitating two separate anastomoses at the IVC.
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Affiliation(s)
- Fadl H Veerankutty
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - T U Shabeer Ali
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Krishnan Sarojam Manoj
- Department of Radiodiagnosis, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - B Venugopal
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
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Raghavapuram R, Veerankutty FH, Anandakumar M. Primary Choriocarcinoma of the Stomach. A Case Report and Review of the Literature. Indian J Surg Oncol 2016; 7:119-23. [PMID: 27065697 DOI: 10.1007/s13193-016-0494-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 01/15/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Rahul Raghavapuram
- Department of Surgical Gastroenterology, Kerala Institute of Medical Sciences, Trivandrum, 695029 India
| | - Fadl H Veerankutty
- Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, Kerala Institute of Medical Sciences, Trivandrum, India
| | - M Anandakumar
- Department of Surgical Gastroenterology, Kerala Institute of Medical Sciences, Trivandrum, 695029 India
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Veerankutty FH, Yeldho V, Tu SA, Venugopal B, Manoj KS, Vidhya C. Hepatoid carcinoma of the pancreas combined with serous cystadenoma: a case report and review of the literature. Hepatobiliary Surg Nutr 2015; 4:354-62. [PMID: 26605284 DOI: 10.3978/j.issn.2304-3881.2015.05.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pancreatic hepatoid carcinoma (HC) is an extremely uncommon neoplasm of pancreas that resembles hepatocellular carcinoma (HCC). We report a case of incidentally detected pancreatic HC combined with a serous microcystic cystadenoma, in a 47-year-old man, while he was being evaluated for renal calculi. Contrast enhanced computed tomography (CECT) of abdomen revealed a lesion with mild heterogeneous enhancement in the tail of pancreas and another proximal lesion having moderate enhancement, and a calculus in the neck of gallbladder. Serum chromogranin, carcinoembryonic antigen (CEA) and CA 19-9 levels were within normal limits. He underwent laparoscopic distal pancreatectomy with splenectomy and cholecystectomy. Pathologically the distal tumor was encapsulated and characterized by eosinophilic cytoplasm, vesicular nucleus with prominent nucleolus and intranuclear eosinophilic inclusions. The cells were arranged in trabecular pattern separated by sinusoids. Canalicular and intercellular bile plugs were seen. On immunohistochemistry tumor cells were positive for hepatocyte specific antigen and weakly positive for alpha fetoprotein (AFP). The proximal tumor showed features of serous microcystic adenoma. Based on these findings, the case was diagnosed as hepatoid tumor of pancreas combined with serous microcystic cystadenoma. Post operative AFP was 1.75 IU/mL. The patient is on follow up for the last eight months and there is no evidence of recurrence.
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Affiliation(s)
- Fadl H Veerankutty
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Varghese Yeldho
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Shabeer Ali Tu
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - B Venugopal
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - Krishnan Sarojam Manoj
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
| | - C Vidhya
- 1 Department of Hepatobiliary Pancreatic and Liver Transplant Surgery, 2 Department of Radiodiagnosis, 3 Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, India
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Iqbal A, Veerankutty FH, Sulfekar MS, Culas TB. Multicentric Jejunal and Omental GIST with an Unusual Clinical Presentation-A Case Report. Indian J Surg Oncol 2014; 5:78-80. [PMID: 24669170 DOI: 10.1007/s13193-014-0292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/21/2014] [Indexed: 12/01/2022] Open
Affiliation(s)
- Abid Iqbal
- Department of General Surgery, Government Medical College Thrissur, Mulamkunnathukavu, Thrissur, Pincode 680596 Kerala India
| | - Fadl H Veerankutty
- Department of General Surgery, Government Medical College Thrissur, Mulamkunnathukavu, Thrissur, Pincode 680596 Kerala India
| | - M S Sulfekar
- Department of General Surgery, Government Medical College Thrissur, Mulamkunnathukavu, Thrissur, Pincode 680596 Kerala India
| | - T B Culas
- Department of General Surgery, Government Medical College Thrissur, Mulamkunnathukavu, Thrissur, Pincode 680596 Kerala India
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