1
|
Wahab MA, Abdel-Khalek EE, Elshoubary M, Yassen AM, Salah T, Sultan AM, Fathy O, Elmorshedi M, Shiha U, Elsadany M, Adly R, Samy M, Shehta A. Predictive Factors of De Novo Malignancies After Living-Donor Liver Transplantation: A Single-Center Experience. Transplant Proc 2021; 53:636-644. [PMID: 33549346 DOI: 10.1016/j.transproceed.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/14/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND De novo malignancies are a major reason of long-term mortalities after liver transplantation. However, they usually receive minimal attention from most health care specialists. The current study aims to evaluate our experience of de novo malignancies after living-donor liver transplantation (LDLT). METHODS We reviewed the data of patients who underwent LDLT at our center during the period between May 2004 and December 2018. RESULTS During the study period, 640 patients underwent LDLT. After a mean follow-up period of 41.2 ± 25.8 months, 15 patients (2.3%) with de novo malignancies were diagnosed. The most common de novo malignancies were cutaneous cancers (40%), post-transplantation lymphoproliferative disorders (13.3%), colon cancers (13.3%), and breast cancers (13.3%). Acute cellular rejection (ACR) episodes occurred in 10 patients (66.7%). Mild ACR occurred in 8 patients (53.3%), and moderate ACR occurred in 2 patients (13.3%). All patients were managed with aggressive cancer treatment. The mean survival after therapy was 40.8 ± 26.4 months. The mean overall survival after LDLT was 83.9 ± 52.9 months. Twelve patients (80%) were still alive, and 3 mortalities (20%) occurred. The 1-, 5-, and 10-year overall survival rates after LDLT were 91.7%, 91.7%, and 61.1%, respectively. On multivariate regression analysis, smoking history, operation time, and development of ACR episodes were significant predictors of de novo malignancy development. CONCLUSIONS Liver transplant recipients are at high risk for the development of de novo malignancies. Early detection and aggressive management strategies are essential to improving the recipients' survival.
Collapse
Affiliation(s)
- Mohamed Abdel Wahab
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | | | - Mohamed Elshoubary
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Amr Mohamed Yassen
- Department of Anesthesia and Intensive Care, College of Medicine, Mansoura University, Egypt
| | - Tarek Salah
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Mohamed Sultan
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Omar Fathy
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Mohamed Elmorshedi
- Department of Anesthesia and Intensive Care, College of Medicine, Mansoura University, Egypt
| | - Usama Shiha
- Diagnostic & Interventional Radiology Department, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Mohamed Elsadany
- Department of Hepatology, College of Medicine, Mansoura University, Egypt
| | - Reham Adly
- Department of Anesthesia and Intensive Care, College of Medicine, Mansoura University, Egypt
| | - Mohamed Samy
- Department of Anesthesia and Intensive Care, College of Medicine, Mansoura University, Egypt
| | - Ahmed Shehta
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.
| |
Collapse
|
2
|
Sultan AM, Shehta A, Salah T, Elshoubary M, Fathy O, Wahab MA. Response to: Effective and Safe Living Donor Hepatectomy Under Intermittent Inflow Occlusion and Outflow Pressure Control. J Gastrointest Surg 2019; 23:1290-1291. [PMID: 30887294 DOI: 10.1007/s11605-019-04191-3] [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: 02/16/2019] [Accepted: 02/26/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Ahmad Mohamed Sultan
- Department of Surgery, Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Shehta
- Department of Surgery, Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt.
| | - Tarek Salah
- Department of Surgery, Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elshoubary
- Department of Surgery, Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Omar Fathy
- Department of Surgery, Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Abdel Wahab
- Department of Surgery, Liver Transplantation Unit, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
3
|
Abdel Wahab M, Shehta A, Ibrahim EM, Eldesoky RT, Sultan AA, Zalata KR, Fathy O, Elshoubary M, Salah T, Yassen AM, Elmorshedi M, Monier A, Farouk A, Shiha U. Adrenalectomy for solitary recurrent hepatocellular carcinoma five years after living donor liver transplantation: A case report. Int J Surg Case Rep 2018; 54:23-27. [PMID: 30513494 PMCID: PMC6279994 DOI: 10.1016/j.ijscr.2018.11.062] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/20/2018] [Accepted: 11/24/2018] [Indexed: 02/09/2023] Open
Abstract
Solitary adrenal recurrence of HCC after LDLT is extremely rare. Strict follow up protocol is necessary to allow early detection of tumor recurrence. Curative surgical resection of solitary recurrent HCC is a safe option. It is associated with low morbidity and expected to have a good long-term survival.
Introduction The adrenal gland is a rare site for hepatocellular carcinoma (HCC) recurrence after living-donor liver transplantation (LDLT). Solitary adrenal recurrence can be managed by surgical excision, with expected better survival outcomes. We describe a rare case of successful left adrenalectomy of solitary recurrent HCC in the left adrenal gland 5 years after LDLT. Presentation 59 years male patient with HCC complicating chronic HCV infection received a right hemi-liver graft from his son. The actual graft weight was 1208 g and GRWR was 1.5. The patient started oral direct acting antiviral drugs for recurrent HCV 2 years after LDLT. A left adrenal mass was detected on follow up radiology. No other metastatic lesions were detected on metastatic workup. Left adrenalectomy was done by an anterior approach. The postoperative course was uneventful and was discharged a week after operation. Postoperative pathological and immune-histochemical examinations confirmed the metastatic HCC nature of the mass. The patient is under regular follow up with no recurrences 6 month after resection. Discussion There is no consensus regarding the management of HCC recurrence after LDLT. Most patients had multi-organ recurrences and usually offered palliative or supportive care. Solitary HCC recurrence offers a better chance for more aggressive therapy, offering better prognosis. Conclusion Solitary adrenal recurrence of HCC after LDLT is extremely rare. Strict follow up protocol is necessary to allow early detection of tumor recurrence. Curative surgical resection is a safe option associated with low morbidity and expected to have a good long-term survival.
Collapse
Affiliation(s)
- Mohamed Abdel Wahab
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Shehta
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.
| | - Eman M Ibrahim
- Department of Pathology, College of Medicine, Mansoura University, Egypt
| | - Rehab T Eldesoky
- Department of Pathology, College of Medicine, Mansoura University, Egypt
| | - Ahmed A Sultan
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Khaled R Zalata
- Department of Pathology, College of Medicine, Mansoura University, Egypt
| | - Omar Fathy
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Mohamed Elshoubary
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Tarek Salah
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Amr M Yassen
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Mohamed Elmorshedi
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Monier
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Farouk
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| | - Usama Shiha
- Diagnostic & Interventional Radiology Department, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt
| |
Collapse
|
4
|
Wahab MA, Shehta A, Elshoubary M, Yassen AM, Elmorshedi M, Salah T, Sultan AM, Fathy O, Elsarraf WR, Shiha U, Zalata K, Elghawalby AN, Eldesoky M, Monier A, Said R, Elsabagh AM, Ali M, Kandeel A, Abdalla U, Aboelella M, Elsadany M, Abdel-Khalek EE, Marwan A, ElMorsi FM, Adly R. Living-Donor Liver Transplantation in Hepatitis C Virus Era: A Report of 500 Consecutive Cases in a Single Center. Transplant Proc 2018; 50:1396-1406. [PMID: 29880362 DOI: 10.1016/j.transproceed.2018.02.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/28/2018] [Accepted: 02/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) is considered a safe alternative to deceased donor liver transplantation (DDLT). In Egypt, DDLT program is still awaited, making LDLT the only hope for patients with end-stage liver disease, mainly due to chronic hepatitis C virus (HCV) infection. The current study is conducted to evaluate our experience of LDLT and discuss the lessons learned from 500 consecutive cases in HCV area. METHODS We reviewed the data of patients who underwent LDLT at Gastrointestinal Surgery Center, Mansoura University during the period between May 2004 and March 2017. RESULTS During the study period, 500 cases underwent LDLT at our unit. The median age was 51 years, and most of our cases were males (446, 89.2%) and had HCV infection (453, 90.6%). The median MELD score was 15. Median ICU stay was 5 days, and hospital stay was 22 days. Postoperative morbidities occurred in 220 cases (44%). Early mortality occurred in 69 patients (13.8%), and late mortality occurred in 45 patients (9%). The 1-, 3-, 5-, and 7-year overall survival rates of all cases were 80.9%, 78.2%, 75.7%, and 75%, respectively. Preoperative creatinine, worm ischemia, blood transfusion, ICU stay, postoperative morbidities, and small for size syndrome were independent predictors for overall survival. CONCLUSIONS In countries lacking DDLT, LDLT is the only effective alternative. LDLT requires a teamwork to achieve successful outcomes. LDLT should only be performed in centers with the adequate experience to avoid and decrease the hazards related to this procedure.
Collapse
Affiliation(s)
- M A Wahab
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A Shehta
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt.
| | - M Elshoubary
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A M Yassen
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - M Elmorshedi
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - T Salah
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A M Sultan
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - O Fathy
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - W R Elsarraf
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - U Shiha
- Diagnostic and Interventional Radiology Department, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - K Zalata
- Department of Pathology, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A N Elghawalby
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - M Eldesoky
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A Monier
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - R Said
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A M Elsabagh
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - M Ali
- Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A Kandeel
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - U Abdalla
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - M Aboelella
- Department of Anesthesia and Intensive Care, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - M Elsadany
- Department of Hepatology, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - E E Abdel-Khalek
- Department of Hepatology, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - A Marwan
- Department of Hepatology, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - F M ElMorsi
- Department of Hepatology, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| | - R Adly
- Department of Hepatology, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
5
|
El Nakeeb A, Askar W, Atef E, Hanafy EE, Sultan AM, Salah T, shehta A, Sorogy ME, Hamdy E, Hemly ME, El-Geidi AA, Kandil T, Shobari ME, Allah TA, Fouad A, Zeid MA, Eneen AAE, El-Hak NG, Ebidy GE, Fathy O, Sultan A, Wahab MA. Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases. World J Gastroenterol 2017; 23:7025-7036. [PMID: 29097875 PMCID: PMC5658320 DOI: 10.3748/wjg.v23.i38.7025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/28/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the evolution, trends in surgical approaches and reconstruction techniques, and important lessons learned from performing 1000 consecutive pancreaticoduodenectomies (PDs) for periampullary tumors.
METHODS This is a retrospective review of the data of all patients who underwent PD for periampullary tumor during the period from January 1993 to April 2017. The data were categorized into three periods, including early period (1993-2002), middle period (2003-2012), and late period (2013-2017).
RESULTS The frequency showed PD was increasingly performed after the year 2000. With time, elderly, cirrhotic and obese patients, as well as patients with uncinate process carcinoma and borderline tumor were increasingly selected for PD. The median operative time and postoperative hospital stay decreased significantly over the periods. Hospital mortality declined significantly, from 6.6% to 3.1%. Postoperative complications significantly decreased, from 40% to 27.9%. There was significant decrease in postoperative pancreatic fistula in the second 10 years, from 15% to 12.7%. There was a significant improvement in median survival and overall survival among the periods.
CONCLUSION Surgical results of PD significantly improved, with mortality rate nearly reaching 3%. Pancreatic reconstruction following PD is still debatable. The survival rate was also improved but the rate of recurrence is still high, at 36.9%.
Collapse
Affiliation(s)
- Ayman El Nakeeb
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Waleed Askar
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ehab Atef
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ehab El Hanafy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmad M Sultan
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Tarek Salah
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed shehta
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El Sorogy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Emad Hamdy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El Hemly
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed A El-Geidi
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Tharwat Kandil
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed El Shobari
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Talaat Abd Allah
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Amgad Fouad
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mostafa Abu Zeid
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Abu El Eneen
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Nabil Gad El-Hak
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Gamal El Ebidy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Omar Fathy
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Sultan
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed Abdel Wahab
- Gastroenterology surgical center, Mansoura University, Mansoura 35516, Egypt
| |
Collapse
|
6
|
El Shobary M, Salah T, El Nakeeb A, Sultan AM, Elghawalby A, Fathy O, Wahab MA, Yassen A, Elmorshedy M, Elkashef WF, Shiha U, Elsadany M. Spray Diathermy Versus Harmonic Scalpel Technique for Hepatic Parenchymal Transection of Living Donor. J Gastrointest Surg 2017; 21:321-329. [PMID: 27798785 DOI: 10.1007/s11605-016-3312-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/13/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Liver parenchymal transection is the most invasive and challenging part in the living donor operation. The study was planned to compare the safety, efficacy, and outcome of harmonic scalpel versus spray diathermy as a method of parenchymal liver transection in donor hepatectomy. PATIENT AND METHOD Eighty consecutive patients, who were treated by living donor liver transplantation (LDLT), were included in the study. The study population was divided into two groups according to the method of liver transection: group A by harmonic scalpel (HS) and group B by spray diathermy (SD). The primary outcome was the volume of blood loss during transection. Secondary outcomes were time of transection, number of ligatures needed during transection, pathological changes at cut surface, postoperative morbidities, cost, and hospital stay RESULTS: Blood loss during overall liver transection and in each zone was significantly less in the SD than in the HS group (P = 0.015). The number of ligatures was significantly less in the SD than in the HS group (P = 0.0001). The SD group had significantly higher level of serum bilirubin, serum glutamic pyruvic transaminase (SGPT), and international normalized ratio (INR) levels on postoperative day 3 than the HS group. Lateral tissue coagulation and hepatic necrosis are significantly less in HS group. The overall incidence of postoperative morbidities was the same in both groups. The cost was higher in HS group than SD group (US$760 vs. US$40 P = 0.0001). CONCLUSION Spray diathermy is an effective method of parenchymal transection with significantly lower blood loss and lower cost compared to HS with no increase in morbidity. HS is associated with earlier recovery of liver functions.
Collapse
Affiliation(s)
- Mohamed El Shobary
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Tarek Salah
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Ayman El Nakeeb
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt.
| | - Ahmad M Sultan
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Ahmed Elghawalby
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Omar Fathy
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Mohamed Abdel Wahab
- Gastrointestinal Surgery and Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Daqahlia, 35516, Egypt
| | - Amro Yassen
- Anesthesia and Intensive Care Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
| | - Mohamed Elmorshedy
- Anesthesia and Intensive Care Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
| | - Wagdi F Elkashef
- Pathology Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
| | - Usama Shiha
- Radiology Department, Gastroenterology Surgical Center, Mansoura University, Daqahlia, Egypt
| | - Mohamed Elsadany
- Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura University, Daqahlia, Egypt
| |
Collapse
|
7
|
Elshobary M, Shehta A, Salah T, Sultan AM, Shiha U, Elghawalby AN, Monier A, Elsadany M, AmrYassen, Fathy O, Wahab MA. Ligation of huge spontaneous porto-systemic collaterals to avoid portal inflow steal in adult living donor liver transplantation: A case-report. Int J Surg Case Rep 2017; 31:214-217. [PMID: 28189982 PMCID: PMC5302135 DOI: 10.1016/j.ijscr.2016.12.020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/27/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In adult living donor liver transplantation (LDLT), maintenance of adequate portal inflow is essential for the graft regeneration. Portal inflow steal (PFS) may occur due to presence of huge spontaneous porto-systemic collaterals. A surgical procedure to increase the portal inflow is rarely necessary in adult LDLT. PRESENTATION A 52 years male patient with end-stage liver disease due to chronic hepatitis C virus infection. Preoperative portography showed marked attenuated portal vein and its two main branches, patent tortuous splenic vein, multiple splenic hilar collaterals, and large lieno-renal collateral. He received a right hemi-liver graft from his nephew. Exploration revealed markedly cirrhotic liver, moderate splenomegaly with multiple collaterals and large lieno-renal collateral. Upon dissection of the hepato-duodenal ligament, a well-developed portal vein could be identified with a small mural thrombus. The recipient portal vein stump was anastomosed, in end to end fashion, to the graft portal vein. Doppler US showed reduced portal vein flow, so ligation of the huge lieno-renal collateral that allows steal of the portal inflow. After ligation of the lieno-renal collateral, improvement of the portal vein flow was observed in Doppler US. DISCUSSION There is no accepted algorithm for managing spontaneous lieno-renal shunts before, during, or after liver transplantation, and evidence for efficacy of treatments remains limited. We report a case of surgical interruption of spontaneous huge porto-systemic collateral to prevent PFS during adult LDLT. CONCLUSION Complete interruption of large collateral vessels might be needed as a part of adult LDLT procedure to avoid devastating postoperative PFS.
Collapse
Affiliation(s)
- Mohamed Elshobary
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - Ahmed Shehta
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt.
| | - Tarek Salah
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - Ahmed Mohamed Sultan
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - Usama Shiha
- Radiology department, Gatroenterology Surgical Centre, Mansoura University, Egypt
| | - Ahmed Nabieh Elghawalby
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - Ahmed Monier
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - Mohamed Elsadany
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - AmrYassen
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - Omar Fathy
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| | - Mohamed Abdel Wahab
- Liver Transplantation Unit, Gatroenterology Surgical Centre, College of Medicine, Mansoura University, Egypt
| |
Collapse
|
8
|
Ali MA, Elshobari MM, Salah T, Kandeel AR, Sultan AM, Elghawalby AN, Shehta A, Elsayed U, Fathy O, Yassen A, Wahab MA. Impact of donor-recipient genetic relationship on outcome of living donor liver transplantation. Liver Transpl 2017; 23:43-49. [PMID: 27516392 DOI: 10.1002/lt.24599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 04/13/2016] [Accepted: 07/28/2016] [Indexed: 02/06/2023]
Abstract
Living donor liver transplantation (LDLT) is a valuable option for expanding the donor pool, especially in localities where deceased organ harvesting is not allowed. In addition, rejection rates were found to be lower in LDLT, which is attributed to the fact that LDLT is usually performed between relatives. However, the impact of genetic relation on the outcome of LDLT has not been studied. In this study, we examined the difference in rejection rates between LDLT from genetically related (GR) donors and genetically unrelated (GUR) donors. All cases that underwent LDLT during the period from May 2004 until May 2014 were included in the study. The study group was divided into 2 groups: LDLT from GR donors and LDLT from GUR donors. A total of 308 patients were included in the study: 212 from GR donors and 96 from GUR donors. Human leukocyte antigen (HLA) typing was not included in the workup for matching donors and recipients. GUR donors were wives (36; 11.7%), sons-in-law (7; 2.3%), brothers-in-law (12; 3.9%), sisters-in-law (1; 0.3%), and unrelated (38; 12.3%). The incidence of acute rejection in the GR group was 17.4% and 26.3% in the GUR group (P value = 0.07). However, there was a significant difference in the incidence of chronic rejection (CR) between the 2 groups: 7% in GR group and 14.7% in the GUR group (P value = 0.03). In terms of overall survival, there was no significant difference between both groups. LDLT from the GUR donors is not associated with a higher incidence of acute cellular rejection. However, CR was significantly lower when grafts were procured from GR donors. HLA matching may be recommended before LDLT from GUR donors. Liver Transplantation 23:43-49 2017 AASLD.
Collapse
Affiliation(s)
- Mahmoud Abdelwahab Ali
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Mohamed Morsi Elshobari
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Tarek Salah
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Al-Refaey Kandeel
- Anesthesia and Intensive Care Department, Mansoura University, Mansoura City, Egypt
| | - Ahmad Mohammad Sultan
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Ahmad Nabieh Elghawalby
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Ahmed Shehta
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Usama Elsayed
- Anesthesia and Intensive Care Department, Mansoura University, Mansoura City, Egypt
| | - Omar Fathy
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| | - Amr Yassen
- Anesthesia and Intensive Care Department, Mansoura University, Mansoura City, Egypt
| | - Mohamed Abdel Wahab
- Liver Transplantation Unit, Gastroenterology Surgical Center, Mansoura University, Mansoura City, Egypt
| |
Collapse
|
9
|
Wahab MA, Shehta A, Hamed H, Elshobary M, Salah T, Sultan AM, Fathy O, Elghawalby A, Yassen A, Shiha U. Hepatic venous outflow obstruction after living donor liver transplantation managed with ectopic placement of a foley catheter: A case report. Int J Surg Case Rep 2015; 10:65-8. [PMID: 25805611 PMCID: PMC4429842 DOI: 10.1016/j.ijscr.2015.03.017] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/08/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022] Open
Abstract
Hepatic venous outflow obstruction is a rare serious complication after liver transplantation. Hepatic venous outflow obstruction may result in graft loss and recipient death. We report the use of the foley catheter to temporary fix the graft and correct the hepatic venous outflow obstruction. It is a simple, cheap and safe device to correct the hepatic venous outflow obstruction. It could be easily monitored and removed under Doppler US without any device related complications.
Introduction The early hepatic venous outflow obstruction (HVOO) is a rare but serious complication after liver transplantation, which may result in graft loss. We report a case of early HVOO after living donor liver transplantation, which was managed by ectopic placement of foley catheter. Presentation A 51 years old male patient with end stage liver disease received a right hemi-liver graft. On the first postoperative day the patient developed impairment of the liver functions. Doppler ultrasound (US) showed absence of blood flow in the right hepatic vein without thrombosis. The decision was to re-explore the patient, which showed torsion of the graft upward and to the right side causing HVOO. This was managed by ectopic placement of a foley catheter between the graft and the diaphragm and the chest wall. Gradual deflation of the catheter was gradually done guided by Doppler US and the patient was discharged without complications. Discussion Mechanical HVOO results from kinking or twisting of the venous anastomosis due to anatomical mismatch between the graft and the recipient abdomen. It should be managed surgically by repositioning of the graft or redo of venous anastomosis. Several ideas had been suggested for repositioning and fixation of the graft by the use of Sengstaken–Blakemore tubes, tissue expanders, and surgical glove expander. Conclusion We report the use of foley catheter to temporary fix the graft and correct the HVOO. It is a simple and safe way, and could be easily monitored and removed under Doppler US without any complications.
Collapse
Affiliation(s)
- Mohamed Abdel Wahab
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Shehta
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
| | - Hosam Hamed
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Mohamed Elshobary
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Tarek Salah
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Mohamed Sultan
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Omar Fathy
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Ahmed Elghawalby
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Amr Yassen
- Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt
| | - Usama Shiha
- Radiology Department, Gatroenterology Surgical Center, Mansoura University, Egypt
| |
Collapse
|
10
|
Wahab MA, Hamed H, Salah T, Elsarraf W, Elshobary M, Sultan AM, Shehta A, Fathy O, Ezzat H, Yassen A, Elmorshedi M, Elsaadany M, Shiha U. Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience. World J Gastroenterol 2014; 20:13607-13614. [PMID: 25309092 PMCID: PMC4188913 DOI: 10.3748/wjg.v20.i37.13607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/03/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
We report our experience with potential donors for living donor liver transplantation (LDLT), which is the first report from an area where there is no legalized deceased donation program. This is a single center retrospective analysis of potential living donors (n = 1004) between May 2004 and December 2012. This report focuses on the analysis of causes, duration, cost, and various implications of donor exclusion (n = 792). Most of the transplant candidates (82.3%) had an experience with more than one excluded donor (median = 3). Some recipients travelled abroad for a deceased donor transplant (n = 12) and some died before finding a suitable donor (n = 14). The evaluation of an excluded donor is a time-consuming process (median = 3 d, range 1 d to 47 d). It is also a costly process with a median cost of approximately 70 USD (range 35 USD to 885 USD). From these results, living donor exclusion has negative implications on the patients and transplant program with ethical dilemmas and an economic impact. Many strategies are adopted by other centers to expand the donor pool; however, they are not all applicable in our locality. We conclude that an active legalized deceased donor transplantation program is necessary to overcome the shortage of available liver grafts in Egypt.
Collapse
|
11
|
Wahab MA, Sultan AM, Salah T, Fathy O, Elebidy G, Elshobary M, Shiha O, Rauf AA, Elhemaly M, El-Ghawalby N. Caudate lobe resection with major hepatectomy for central cholangiocarcinoma: is it of value? ACTA ACUST UNITED AC 2013; 59:321-4. [PMID: 22328268 DOI: 10.5754/hge11999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIMS The aim of this study was to evaluate the importance of concomitant caudate lobe resection in the course of major hepatectomy for hilar cholangiocarcinoma. METHODOLOGY During the period between January 1995 and December 2010, 159 patients were subjected to major hepatectomy with or without total caudate lobe resection at the Gastroenterology Centre, Mansoura University. These patients were divided in two groups: 1) a caudate lobe preservation (CLP) group (79 patients) and 2) a caudate lobe resection (CLR) group (80 patients). All patient data were retrospectively reviewed. RESULTS This study included 94 men and 65 women with a mean age of 53.5±0 years without operative mortality. No differences were observed between groups regarding operative time, blood loss or the development of any individual postoperative complication. There were 23 (28.8%) margin-positive resections in the CLR group and 49 (62%) margin-positive resections in the CLP group (p≤0.001). Recurrence was confirmed in 53 (67.1%) and in 41(51.3%) patients in the CLP and CLR groups, respectively (p=0.031). The median survival of the CLR group was 36 months with a 5-year survival rate of 28%, while the median survival of the CLP group was 22 months with a 5-year survival rate of 5% (p≤0.001). CONCLUSIONS Caudate lobe resection in combination with major hepatectomy did not affect operative or postoperative morbidity and mortality. However, it led to higher rates of margin-negative resections and significantly improved survival.
Collapse
|
12
|
Wahab MA, Fathy O, Elhanafy E, Atif E, Sultan AM, Salah T, Elshoubary M, Anwar N, Sultan A. Caudate lobe resection for hepatocellular carcinoma. Hepatogastroenterology 2012. [PMID: 22024060 DOI: 10.5754/hge11324.] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) originating in the caudate lobe is rare, and the treatment for this type of carcinoma is a complex surgical procedure. We aimed to evaluate the surgical outcomes after isolated caudate lobe resection for HCC. METHODOLOGY We retrospectively analyzed 30 consecutive patients with HCC originating in the caudate lobe who underwent isolated caudate lobe resection. RESULTS Thirty patients underwent caudate lobe resection for HCC. The main sites of the tumors were located in the Spiegel lobe, the paracaval portion and caudate process. The surgical margin was tumor negative in all of the patients. The median tumor size was 4.3cm. The mean operative time was 230 ± 50min and the intraoperative blood loss was 1200 ± 200mL. The hospital morbidity rate was 33%. There was no postoperative mortality. The mean survival rate was 25.3+11.7 months. The overall survival rates were 62%, 34% and 11% at 1, 3 and 5 years, respectively. The disease free survival rate after isolated caudate lobectomy was 31% at 3 years. Recurrence was noted in 12 patients (40%). Eleven patients were identified as having intrahepatic recurrences and 1 patient as having peritoneal dissemination. CONCLUSIONS Isolated caudate lobe resection is a feasible procedure and can be undertaken with low morbidity and nil mortality. Careful technique and detailed anatomic knowledge of the caudate lobe are essential for this procedure.
Collapse
|
13
|
Wahab MA, Fathy O, Elhanafy E, Atif E, Sultan AM, Salah T, Elshoubary M, Anwar N, Sultan A. Caudate Lobe Resection for Hepatocellular Carcinoma. ACTA ACUST UNITED AC 2011; 58:1904-8. [DOI: 10.5754/hge11324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
14
|
Fathy O, Wahab MA, Hamdy E, Elshoubary M, Kandiel T, Elraof AA, Elhemaly M, Salah T, Elhanafy E, Atef E, Sultan AM, Elebiedy G, Anwar N, Sultan A. Post-cholecystectomy biliary injuries: one center experience. Hepatogastroenterology 2011; 58:719-724. [PMID: 21830376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIMS Post-cholecystectomy bile duct injuries (BDIs) represent a challenge in diagnosis and management. METHODOLOGY From March 1995 to August 2009, 274 patients with post-cholecystectomy BDIs were managed at our center. All patients were subjected to laboratory tests, sonography, ERCP and MRCP. The management varied according to the type of injury. RESULTS Seventy-one (25.9%) LC and 203 (74.1%) OC were performed; 8(2.9%) were detected intraoperatively; 270 patients were referred from other hospitals. From those discovered intraoperatively, 7 had hepatico-jejunostomy and one died from severe peritonitis; 11 (4%) presented with generalized and 112 (40.9%) with localized peritonitis. The leak site was the cystic duct (57 cases), accessory duct in the liver bed (5 cases), right hepatic duct (4 cases) and lateral tear in the CBD (12 cases). Endoscopic stenting was performed for all of them. The remaining 34 patients had a completely ligated distal duct and therefore had hepatico-jejunostomy Roux loop; 143 patients (52.2%) presented with early (79 cases) and late (64 cases) jaundice; 126 cases had hepatico-jejunostomy. The remaining 17 patients were treated by balloon dilatation. CONCLUSIONS Endoscopic stenting can manage cases with cystic or accessory duct leak while, hepatico-jejunostomy Roux loop represents the golden procedure for management of transected or ligated CBD.
Collapse
Affiliation(s)
- Omar Fathy
- Gastroenterology Center, Mansoura University, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
El-Raouf AA, Hak NG, Fathy O, El-Ebidy G, Salah T, El-Hemaly M. Outcome of pouch surgery for ulcerative colitis: single center experience. Hepatogastroenterology 2008; 55:2130-2134. [PMID: 19260491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The purpose of the present study is to present the experience and evaluate the outcome of pouch surgery for patients with ulcerative colitis (UC). METHODOLOGY Fifty eight patients underwent surgery for UC between 1996 and 2007 at Mansoura Gastroenterology Center. A retrospective analysis has been done of all patients with UC undergoing surgery which includes details of the patient's history, indication of surgery, type of operation, postoperative morbidity, and functional outcome. RESULTS The main indication for operation was failed medical treatment (n=42, 72.4%). Pouch surgery was performed in 25/58 patients (43.1%). The majority of patients, 23/25 (92%) had J-shaped pouch and most patients, 19 (76%), underwent a stapled anastomosis. Twenty patients (80%) had a defunctioning ileostomy. There was one postoperative death after pouch surgery. Early complications after pouch surgery included pelvic sepsis (n=4), small bowel obstruction (n=2), pouch hemorrhage (n=1), wound sepsis (n=3). Long-term follow-up data were available for 14 patients. The most common long-term complication was anastomotic stricture (n=9, 42.6%). Five patients (35.7%) presented with pouchitis. Median daytime stool frequency was 5.1. Three patients (21.4%) presented with fecal incontinence. CONCLUSION Pouch surgery is a major one that attains many complications. However, the long term results and patient's satisfaction are reasonable.
Collapse
|
16
|
Fathy O, Abdel-Wahab M, Elghwalby N, Sultan A, El-Ebidy G, Abu-Zeid M, Abd-Allah T, El-Shobary M, Fouad A, Kandeel T, Abo-Elenien A, El-Hah NG, Abdel-Raouf A, Sultan AM, Ezzat F. Surgical management of peri-ampullary tumors: a retrospective study. Hepatogastroenterology 2008; 55:1463-1469. [PMID: 18795713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND/AIMS Surgical resection still remains the best treatment for patients with periampullary tumors. This study aims to present the results of surgical treatment of this disease at our center. METHODOLOGY Between January 1995 and December 2004, 216 periampullary tumors were treated by surgical resection. The mean age was 58 years with male to female ratio 2:1. The most common symptom was jaundice (97.7%). Abdominal pain occurred in 74% of patients. Pancreaticogastrostomy was done in 183 patients and pancreaticojejunostomy in 33 patients. RESULTS Operative mortality occurred in 7 patients (3.2%). The median survival was 22.6 months for patients with ampullary tumors and 16.6 months for patients with pancreatic head tumors. Early operative complications occurred in 33% of patients; the most common one was wound infection (11.6%), pancreatic leak (10.6%), abdominal collection (10.6%) and delayed gastric emptying (8.8%). Factors associated with increased risk of developing complications were the type of pancreatico-enteric anastomosis (pancreatic leak was more frequent with pancraticojejunostomy), soft pancreatic texture and intraoperative blood transfusion of more than 4 units. Factors associated with better survival included tumor diameter (less than 3cm), origin (ampullary), differentiation (well differentiated) and margin status (negative resection margins). CONCLUSIONS Postoperative complications of pancreaticoduodenectomy, especially with the adoption of pancreaticogastrostomy, occur with reasonable incidence. Survival largely depends on the origin of the tumor.
Collapse
Affiliation(s)
- O Fathy
- Gastroenterology Center, Mansoura University, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Fathy O, Wahab MAM, Elghwalby N, Sultan A, EL-Ebidy G, Hak NG, Abu Zeid M, Abd-Allah T, El-Shobary M, Fouad A, Kandeel T, Abo Elenien A, Abd El-Raouf A, Hamdy E, Sultan AM, Hamdy E, Ezzat F. 216 cases of pancreaticoduodenectomy: risk factors for postoperative complications. Hepatogastroenterology 2008; 55:1093-1098. [PMID: 18705336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND/AIMS Surgical resection remains the best treatment for patients with periampullary tumors. Many series have been reported with low or zero mortality, however, high incidence of complications is the rule. This study aims to present the results of pancreaticoduodenectomy and factors predisposing to postoperative complications, especially pancreatic leak, at our center. METHODOLOGY Between January 2000 and December 2006, 216 periampullary tumors were treated by Whipple pancreaticoduodenectomy. Pancreaticogastrostomy was done in 183 patients and pancreaticojejunostomy in 33 patients. Hospital mortality and surgical complications were recorded with special emphasis on pancreatic leak. All specimens were histologically examined for the presence and origin of malignant tissue. RESULTS The mean age was 58 years and male to female ratio was 2:1. The commonest symptom was jaundice (97.7%) followed by abdominal pain (74%). Operative mortality in 7 patients (3.2%). 71 (33%) patients developed 1 or more complications, pancreatic leak occurred in 23 (10.6%) patients, abdominal collection in 23 patients (10.6%) and delayed gastric emptying in 19 (8.8%) patients. Factors that influenced the development of postoperative complications included type of pancreaticoenteric anastomosis, pancreatic texture and intraoperative blood transfusion of 4 or more blood units. Pancreatic leak was commoner with PJ (p=0.001), soft pancreatic texture (p=0.008), intraoperative blood transfusion of 4 or more units (p<0.0001). Periampullary adenocarcinoma was found in 204 (94.4%) patients, chronic pancreatitis in 9 (4.2%) patients, 2 patients with solid and papillary neoplasm, and 1 patient with NHL (Non-Hodgkin's Lymphoma). CONCLUSIONS Surgery is the only hope for patients with periampullary tumors. Postoperative complications after pancreaticoduodenectomy depend largely on surgical technique and can be reduced reasonably with the adoption of pancreaticogastrostomy, which is safer and easier to learn than pancreaticojejunostomy.
Collapse
Affiliation(s)
- O Fathy
- Gastroenterology Surgical Center, Mansoura University, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Lo AC, Soliman AS, El-Ghawalby N, Abdel-Wahab M, Fathy O, Khaled HM, Omar S, Hamilton SR, Greenson JK, Abbruzzese JL. Lifestyle, occupational, and reproductive factors in relation to pancreatic cancer risk. Pancreas 2007; 35:120-9. [PMID: 17632317 DOI: 10.1097/mpa.0b013e318053e7d3] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study examined the epidemiology of pancreatic cancer in Egypt. METHODS We obtained detailed information on smoking, occupational, medical, and reproductive histories from 194 pancreatic cancer cases and 194 controls. RESULTS Compared with not smoking, smoking cigarettes alone or in conjunction with other smoking methods (eg, water pipe, cigar) was associated with an increased risk (odds ratio [OR], 4.5 and 7.8; 95% confidence interval [95% CI], 1.9-10.7 and 3.0-20.6, respectively). Passive smoking was also a significant risk factor (OR, 6.0; 95% CI, 2.4-14.8). The risk of pancreatic cancer was elevated among subjects exposed to pesticides (OR, 2.6; 95% CI, 0.97-7.2). A prior diagnosis of diabetes mellitus for a period of 10 years was associated with higher risk (OR, 5.4; 95% CI, 1.5-19.9). For women, having 7 or more live births and lactating for 144 months or longer were associated with a reduced risk (OR, 0.5 and 0.2; 95% CI, 0.2-1.3 and 0.1-0.9, respectively). No association was found between family history, allergy, or obesity and pancreatic cancer in Egypt. CONCLUSIONS Multiple tobacco consumption methods, passive smoking, pesticide exposures, and diabetes are associated with an increased risk for pancreatic cancer. Prolonged lactation and increased parity are associated with a reduced risk for pancreatic cancer.
Collapse
Affiliation(s)
- An-Chi Lo
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abdel-Wahab M, El-Ghawalby N, Mostafa M, Sultan A, El-Sadany M, Fathy O, Salah T, Ezzat F. Epidemiology of hepatocellular carcinoma in lower Egypt, Mansoura Gastroenterology Center. Hepatogastroenterology 2007; 54:157-62. [PMID: 17419252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) is now regarded as one of the major malignant diseases worldwide, with significant variations in its epidemiology. OBJECTIVE study of the epidemiology of hepatocellular carcinoma and its relation to age, sex, residence, and viral hepatitis in Egypt. METHODOLOGY From January 1992 to May 2005, 1012 cases with hepatocellular carcinoma were diagnosed in the Gastroenterology Center, Mansoura University, Egypt. All patients were evaluated for age, sex, residence, occupation, history of other medical disease, anti-bilharzial treatment, blood transfusion, viral markers, and liver functions. RESULTS The mean age was 54.26 +/- 9.2, with high prevalence between 51 and 60 years. Male to female ratio was 5:1, farmers constituted 37.6%, workers 22.9% and housewives 12.8% of the patients. The number of HCC patients increases yearly from only 9 patients evaluated at 1992 to 80 patients in the first 5 months of the year 2005. The mean age increased from 45 years at 1992 up to 58 years at year 1996. Seventy-seven percent of the patients were resident in rural areas versus 23% in urban areas. Seventy-eight percent of patients presented with abdominal pain, 7.1% with abdominal swelling, 4.3% with jaundice, 2.4% with other symptoms and 8.8% of the HCCs were discovered accidentally. The prevalence of diabetes mellitus among HCC patients was 13.6%, history of anti-bilharzial treatment was positive in 37.6%. Hepatitis C, B and mixed B&C was 76.6%, 3.3%, 3.6% respectively. History of blood transfusion was encountered in only 10.6%. Twenty-seven percent of HCC patients had previous history of surgery. Clinical and laboratory studies revealed that, 52.1% of patients were Child's A, 37.3% B and 10.7% C. Tumor size >5 cm in 65.5%, the right lobe was the site in 63.9%, left lobe in 25.8% and both lobes in 10.3% of the patients. Lesions were single in 71.1%, multiple in 24.9% and diffuse in 4% of cases. Portal vein thrombosis was detected in 15.9%. Hepatic resection was done in 25.8%, chemoembolizations in 17.2%, radiofrequency in 13.1%, alcohol injection in 0.9%, mixed treatment in 3.5% of patients while 38.7% were managed by conservative treatment due to no available safe treatment. CONCLUSIONS The number of newly diagnosed patients with HCC increases annually. The prevalence of HCC is high in Nile Delta area, and is more common in males, rural residents and farmers especially in HCV patients. In rural areas there are other risk factors that may be responsible for this high incidence, such as pollution, aflatoxins and use of insecticides, which need more study.
Collapse
|
20
|
Soliman AS, Wang X, Stanley JD, El-Ghawalby N, Bondy ML, Ezzat F, Soultan A, Abdel-Wahab M, Fathy O, Ebidi G, Abdel-Karim N, Do KA, Levin B, Hamilton SR, Abbruzzese JL. Geographical clustering of pancreatic cancers in the Northeast Nile Delta region of Egypt. Arch Environ Contam Toxicol 2006; 51:142-8. [PMID: 16453066 DOI: 10.1007/s00244-005-0154-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 09/26/2005] [Indexed: 05/06/2023]
Abstract
The northeast Nile Delta, Egypt's most polluted region, appears to have a high incidence of pancreatic cancer. We sought to determine whether there is any geographic clustering of pancreatic cancers there and, if so, whether such clustering might be associated with environmental pollution. Using data from the medical records of the Gastrointestinal Surgical Center of Mansoura University in the Dakahleia Province of Egypt and detailed geographical maps of the northeast Nile Delta region, we plotted the residences of all 373 patients who had pancreatic cancer diagnosed between 1995 and 2000. The study region has 15 administrative districts, whose centroid coordinates, population, and number of pancreatic cancer patients were determined for this study. Monte Carlo simulation identified statistically significant clustering of pancreatic cancer in five subdivisions located near the Nile River and Delta plains. This clustering was independent of population size and formed two larger clusters. When data were analyzed by sex, clustering of pancreatic cancer was observed in the same five subdivisions for men but only two subdivisions showed clustering for women. Together, our data suggest that there is clustering of pancreatic cancer cases in the northeast Nile delta region and that this clustering may be related to water pollution. Our data also warrant future studies of the association between water pollution and pancreatic cancer in the region.
Collapse
Affiliation(s)
- A S Soliman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abdel Wahab M, Fathy O, Elghwalby N, Sultan A, Elebidy E, Abdalla T, Elshobary M, Mostafa M, Foad A, Kandeel T, Abdel Raouf A, Salah T, Abu Zeid M, Abu Elenein A, Gad Elhak N, ElFiky A, Ezzat F. Resectability and prognostic factors after resection of hilar cholangiocarcinoma. Hepatogastroenterology 2006; 53:5-10. [PMID: 16506367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND/AIMS Hilar cholangiocarcinoma, still a challenging problem for surgeons and resectional surgery, is the treatment of choice for long-term survival. In this study we tried to evaluate different prognostic factors after resection. METHODOLOGY From January 1995 to October 2004, 440 patients with hilar cholangiocarcinoma were admitted to the Gastroenterology Surgical Center, Mansoura University, Egypt. Of these patients 73 underwent potentially curative resection giving respectability rate of 17%, and the remaining 367 patients underwent non-surgical treatment because of advanced disease, advanced cirrhosis and poor general condition. Of the 73 patients, 35 (48%) underwent localized hepatic resection and 38 (52%) patients underwent major hepatic resection. Various prognostic factors for survival were evaluated by univariate and multivariate analysis. RESULTS Hospital mortality occurred in 8 (11%) patients. The most common postoperative complications were: bile leak, liver cell failure and wound infection 23.2%, 17.8% and 9.5% respectively. The survival rates at 1, 2, 3, 4, and 5 years were 79%, 32.6, 18.5, 137% and 13% respectively. The result of univariate analysis revealed that radicality of resection, lymph nodes status, tumor differentiation, modified Bismuth staging, underlying liver pathology, HCV viral infection, blood transfusion, preoperative serum bilirubin <10mg and CA19-9 are dependent prognostic factors. By multivariate Cox analysis radicality of resection, lymph nodes status, serum bilirubin below 10mg/dL level of CA19-9 and hepatitis viral infection were independent predictor factors. CONCLUSIONS From this study we found that aggressive surgical procedure to obtain curative resection with preoperative serum bilirubin below 10mg and HCV infective negative especially in noncirrhotic liver may bring a better prognosis in hilar cholangiocarcinoma.
Collapse
Affiliation(s)
- M Abdel Wahab
- Gastroenterology Center, Mansoura University, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Kriegel AM, Soliman AS, Zhang Q, El-Ghawalby N, Ezzat F, Soultan A, Abdel-Wahab M, Fathy O, Ebidi G, Bassiouni N, Hamilton SR, Abbruzzese JL, Lacey MR, Blake DA. Serum cadmium levels in pancreatic cancer patients from the East Nile Delta region of Egypt. Environ Health Perspect 2006; 114:113-9. [PMID: 16393667 PMCID: PMC1332665 DOI: 10.1289/ehp.8035] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 08/25/2005] [Indexed: 05/06/2023]
Abstract
UNLABELLED The northeast Nile Delta region exhibits a high incidence of early-onset pancreatic cancer. It is well documented that this region has one of the highest levels of pollution in Egypt. Epidemiologic studies have suggested that cadmium, a prevalent pollutant in the northeast Nile Delta region, plays a role in the development of pancreatic cancer. OBJECTIVE We aimed to assess serum cadmium levels as markers of exposure in pancreatic cancer patients and noncancer comparison subjects from the same region in Egypt. DESIGN AND PARTICIPANTS We assessed serum cadmium levels of 31 newly diagnosed pancreatic cancer patients and 52 hospital comparison subjects from Mansoura, Egypt. EVALUATION/MEASUREMENTS: Serum cadmium levels were measured using a novel immunoassay procedure. RESULTS We found a significant difference between the mean serum cadmium levels in patients versus comparison subjects (mean+/-SD, 11.1+/-7.7 ng/mL vs. 7.1+/-5.0 ng/mL, respectively; p=0.012) but not in age, sex, residence, occupation, or smoking status. The odds ratio (OR) for pancreatic cancer risk was significant for serum cadmium level [OR=1.12; 95% confidence interval (CI), 1.04-1.23; p=0.0089] and farming (OR=3.25; 95% CI, 1.03-11.64; p=0.0475) but not for age, sex, residence, or smoking status. CONCLUSIONS The results from this pilot study suggest that pancreatic cancer in the East Nile Delta region is significantly associated with high levels of serum cadmium and farming. RELEVANCE TO CLINICAL PRACTICE/PUBLIC HEALTH: Future studies should further investigate the etiologic relationship between cadmium exposure and pancreatic carcinogenesis in cadmium-exposed populations.
Collapse
Affiliation(s)
- Alison M Kriegel
- Department of Biochemistry, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Soliman AS, Bondy M, Webb CR, Schottenfeld D, Bonner J, El-Ghawalby N, Soultan A, Abdel-Wahab M, Fathy O, Ebidi G, Zhang Q, Greenson JK, Abbruzzese JL, Hamilton SR. Differing molecular pathology of pancreatic adenocarcinoma in Egyptian and United States patients. Int J Cancer 2006; 119:1455-61. [PMID: 16619252 DOI: 10.1002/ijc.21986] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Variations in genetic mutations in pancreatic carcinoma between different populations have not been studied extensively, especially in developing countries where pancreatic cancer is rare. We studied the molecular pathology of 44 pancreatic carcinomas from patients residing in a heavily polluted region in the Nile River delta and compared the findings with tumors from 44 United States (US) patients. We evaluated K-ras mutations in codon 12, p53 mutations in exons 5-8, and Gadd45a mutations in exons 1 and 4. Overall, rates of K-ras, p53 and Gadd45 mutations were not statistically different in tumors of patients from Egypt and the US (67.4 vs. 63.4%; 27.3 vs. 36.4% and 9.1 vs. 4.5%, respectively). However, there were distinct differences in the specific types of K-ras and p53 mutations between the 2 groups. In K-ras, G --> T transversion mutation was more frequent in the tumors from Egypt than from the US (58.6 vs. 26.9%), whereas G --> C transversion was detected in 26.9% of US tumors but none from Egypt (p = 0.003). We also found a trend toward differences in the p53 exons in which mutations occurred, with higher frequency of exon 5 mutation and lower frequency of exon 6 mutation in Egyptian tumors. Logistic regression showed that K-ras G --> T transversion mutations and p53 exon 6 mutations were predicted by the country of residence of the patients. Our study identifies that there are differences in the types of mutations found in tumors from pancreatic carcinoma patients in Egypt and the US, and suggests that environmental factors may explain these differences.
Collapse
Affiliation(s)
- Amr S Soliman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Abdel Wahab M, Fathy O, Elghwalby N, Sultan A, Mostafa M, El-Baz M, Elsaadany M, Elshobary M, Ezzat F. Primary hepatic carcinoid tumor: one Egyptian center experience. Hepatogastroenterology 2006; 53:33-8. [PMID: 16506372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND/AIMS Carcinoid tumors of the liver are rare and pose both a diagnostic and therapeutic dilemma. Our aim was to study the diagnosis and treatment of primary hepatic carcinoid and to highlight its incidence in relation to hepatocellular carcinoma in our series and review of literature. METHODOLOGY Between March 1992 and May 2005, we managed 5 patients (1 male, 4 females) with primary hepatic carcinoid in our center. RESULTS The main presentation was upper abdominal pain with palpable mass, while in one patient tumor was discovered accidentally, none of them had carcinoid syndrome. The tumors were located in the left lobe in one patient, caudate lobe in two patients and right lobe in two patients. The diagnosis was confirmed histologically with light microscopy and immunohistochemistry. Four patients remain alive and disease free after follow-up of 72, 18, 16, and 4 months. One patient died after 11 years of follow-up with recurrence after 10 years, with mean follow-up of 45.2 +/- 53.1 months in May 2005. CONCLUSIONS Primary hepatic carcinoid tumor is rare. It occurs on top of non-cirrhotic liver. Hepatic resection even in large-sized tumor is the treatment of choice.
Collapse
Affiliation(s)
- M Abdel Wahab
- Gastroenterology Center, Mansoura University, Egypt.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Gad El-Hak N, Abo Zied M, Aboelenen A, Fouad A, Abd Alla T, El-Shoubary M, Kandel T, Hamdy E, Abdel Wahab M, Fathy O, El-ebidy G, Sultan A, Elfiky A, Elghwalby N, Ezzat F. Short gastric vessels division in Laparoscopic Nissen Fundoplication. Hepatogastroenterology 2005; 52:1742-7. [PMID: 16334770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND/AIMS To divide or not the short gastric vessels during Laparoscopic Fundoplication (LF) is still controversial. This retrospective study is based on short gastric vessels division (SGVsD), if necessary, during LF to construct a satisfactory loose wrap and to evaluate its effect upon the symptomatic and physiologic outcome in patients with proven GERD. METHODOLOGY 150 patients (90 males, 60 females) with a mean age of 37 +/- 9 with typical symptoms of GERD, adequate motility study and positive 24-hour pH studies underwent LF; 100 (66.7%) were feasible after careful and complete fundal dissection without SGVsD while, 50 (33.3%) were not possible except with SGVsD. Outcome measures included assessment of the relief of the primary symptom responsible for surgery; repeated upper endoscopy and barium study. Postoperative 24-hour esophageal pH and LES manometry were performed in 110 patients. RESULTS The mean operative time was prolonged with short gastric division (130 +/- 60 vs. 90 +/- 40 minutes). At a mean period of follow-up of 35 +/- 12 months, relief of the primary symptom responsible for surgery was achieved in 92.2% of patients with division and 87.5% of patients without. Recurrent attacks of abdominal distension were documented in 2 patients (5.6%) with division and 12 patients (16%) without division. Occasional dysphagia not present before surgery occurred in 27 patients at 3 months; 11 (31.4%) with division and 16 (21.3%) without, and decreased to 11 patients by 12 months after surgery; 2 (5.7%) with division and 9 (12%) without; only one case of those without division required 5 sets of endoscopic dilatation. Endoscopic esophagitis healed in all patients with division and 71 of 75 patients (94.7%) without. LES pressures had returned to normal in all patients except one case without division (1.3%) with a higher mean pressure among those without division (22.3 mmHg vs. 18.5 mmHg) and a better relaxation with division (89.9% vs. 80.5%). 24-hour esophageal acid exposure had returned to normal in 33 of 35 patients (94.3%) with division and 66 of 75 patients (88%) without. CONCLUSIONS Construction of a satisfactory loose Nissen Fundoplication was feasible in two thirds of patients without SGVsD. Despite prolongation of the operative time, SGVsD provides a better symptomatic and physiologic outcome.
Collapse
Affiliation(s)
- N Gad El-Hak
- Gastroenterology Surgical Center, Mansoura University, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
El-Hak NAG, Zeid MA, Aboelemen A, Fouad A, Abd Alla T, El Shoubary M, Kandel T, Hamdy E, Abdel Wahab M, Fathy O, El Ebidy G, Sultan A, Elfiky A, Elghwalby N, Ezzat F. Partial posterior wrap (toupet)in patients with defective esophageal body motility. Saudi J Gastroenterol 2005; 11:73-84. [PMID: 19861849 DOI: 10.4103/1319-3767.33323] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The effectiveness of partial posterior wrap (Toupet procedure) in patients with defective esophageal body motility is controversial. AIM OF THE STUDY To evaluate the effect of Toupet procedure upon the outcome of laparoscopic (LF) and open (OF) fundoplications in gastroesophageal reflux disease (GERD) patients with defective esophageal body motility. PATIENTS AND METHODS This study included 32 patients with severe GERD who underwent Toupet procedure; 18 (56.25%) OF 'and 14 (43.75%) LF. Outcome measures included assessment of relief of the symptoms, results of repeated endoscopy, barium study, manometry and pH metry; both early (within six months) and late (two years at least). RESULTS Relief of heartburn was achieved in 26 patients (81.3%). These include 14 (77.7%) and 12 (85.7%) patients who underwent OF and LF respectively. Occasional dysphagia developed in six patients (18.7%) early, and three (9.4%) late; all were managed conservatively. Endoscopic esophagitis healed in 26 patients (81.3%); 14 (77.7%) OF and 12 (85.7%) LF. Mean LES and body pressures improved (10.5 to 17.7 and 29.0 to 41.0 mmHg respectively). Persistent acid reflux was detected in six patients (18.7%); two (22.3%) OF and two (14.3%) LF. CONCLUSION Toupet fundoplication is an effective procedure for reflux control except in patients with severe GERD.
Collapse
|
27
|
Abdel Wahab M, Sultan A, el-Ghawalby N, Fathy O, Abu Zeid M, Abu el-Enin A, Abdallah T, Foad A, Kandeel T, el-Shobari M, el-Fiky A, el-Ebidy G, Gadel Hak N, Ezzat F. Hepatic resection in cirrhotic liver for treatment of hepatocellular carcinoma in Egyptian patients. Experience with 140 cases in a single center. Hepatogastroenterology 2004; 51:559-63. [PMID: 15086202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND/AIMS In many centers hepatic resection is still the treatment of choice for hepatocellular carcinoma in cirrhotic liver. Several factors affect the prognosis; one of them is the extent of resection. This study retrospectively evaluates outcome after different types of hepatic resection in cirrhotic liver. METHODOLOGY Hepatectomy was performed in 245 patients. From them, 140 patients were subjected to hepatic resection for hepatocellular carcinoma in cirrhotic liver. According to the type of resection the patients were divided into three groups (A, B and C), major resection (group A) in 79 (56.3%), segmental resection (group B) 31 (22.1%) and localized resection (group C) in 30 (21.4%). Early postoperative mortality and morbidity as well as long-term survival and recurrence were assessed. RESULTS The overall hospital mortality rate was (8.6%) with total complications 26%, recurrence rate 32.8% and median survival was 24 months (3-120). Group A showed high incidence rate of hospital mortality, total complications and hepatic cell failure than the other two types (p>0.05). On the other hand, group C patients showed high incidence of wound infection and recurrence rate after hepatic resection than the other two types (p>0.05). At the end of the study, the median survival was 18 months (4-120), 24 months (3-48) and 24 months (3-120) for the three groups respectively without significant difference. The overall 5-year survival rate was 20%, 0% and 15.3% for the three groups respectively (p>0.05). CONCLUSIONS Although major liver resection in cirrhotic liver has high incidence of early mortality and morbidity, it gives low incidence of recurrence and better survival in comparison with segmental and localized resection. However it has to be reserved for large tumor in good liver and early cirrhosis.
Collapse
Affiliation(s)
- M Abdel Wahab
- Gastroenterology Center, Mansoura University, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Soliman AS, El-Ghawalby N, Ezzat F, Bondy ML, Soultan A, Abdel-Wahab M, Fathy O, Ebidi G, Bassiouni N, El-Ghawalbi A, Levin B, Abbruzzese JL. Unusually high rate of young-onset pancreatic cancer in the East Nile Delta region of Egypt. Int J Gastrointest Cancer 2003; 32:143-51. [PMID: 12794251 DOI: 10.1385/ijgc:32:2-3:143] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pancreatic cancer is predominantly a disorder of the elderly population in the United States. In Egypt, the disease has traditionally been considered rare, and there has not been a previous publication on its population-based incidence or age distribution. METHODS We reviewed the records of 728 pancreatic cancer patients seen at the Gastrointestinal Surgery Center of Mansoura University in the East Nile Delta region of Egypt between 1995 and 2000. We computed population-based, age-specific, and age-adjusted incidence rates in this population and compared them with US incidence rates from the Epidemiology Surveillance and End Results (SEER) Program. We also analyzed clinical characteristics of the patients, as well as their surgical and medical management. RESULTS Approximately one-fourth of all patients were under age 50. The mean ages of patients who had undergone Whipple's resection, other surgical procedures, and no surgical procedure were 52.9 +/- 11.6, 54.11 +/- 10.5, and 55.1 +/- 14.1 yr, with no statistically significant differences. Age-adjusted incidence rates were higher in Egyptian patients than in US patients under age 65 (7.1/100,000 vs 3.3/100,000) but were much higher in US patients than in Egyptian patients over age 65 (6.6/100,000 vs 59.1/100,000). Clinical management did not differ between patients under and over age 50. CONCLUSION The population in the East Nile Delta region of Egypt exhibits an unusually high rate of young-onset pancreatic cancer. Further studies to investigate the epidemiology of pancreatic cancer in this population may provide clues to its etiology.
Collapse
Affiliation(s)
- Amr S Soliman
- Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center Houston, TX 77030, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Fathy O, Zeid MA, Abdallah T, Fouad A, Eleinien AA, el-Hak NG, Eleibiedy G, el-Wahab MA, Sultan A, Anwar N, Ezzat F. Laparoscopic cholecystectomy: a report on 2000 cases. Hepatogastroenterology 2003; 50:967-71. [PMID: 12845960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND/AIMS This is a retrospective study to evaluate the results of laparoscopic cholecystectomy after 2000 cases at a single center. METHODOLOGY Between June 1992 and February 2000, 2000 patients (1458 females and 542 males, mean age 39.8 years) with symptomatic gallstones underwent laparoscopic cholecystectomy. All cases were diagnosed by abdominal ultrasonography. Preoperative endoscopic retrograde cholangiopancreatography was done for 31 patients. Four trocars were used for all except 20 cases. RESULTS The mean operative time was 45 +/- 15 minutes. Conversion to open cholecystectomy occurred in 147 patients (7.35%). Adhesions were the commonest cause of conversion (2.9%). There was no technique-related mortality. Bile duct injury occurred in 7 cases (0.35%), reconstruction by Rouxen-Y hepaticojejunostomy was necessary in 5 cases and the injury was successfully managed by endoscopic stent in 2 cases. Bile leakage occurred in 11 cases (0.55%), peritonitis in 5 cases (0.25%), internal hemorrhage in 9 cases (0.45%), cystic artery injury in 17 cases (0.85%), pneumothorax in one case (0.05%) and subcutaneous emphysema in 3 cases (0.15%). CONCLUSIONS Laparoscopic cholecystectomy is a good alternative to open cholecystectomy with an acceptable morbidity. Conversion to open cholecystectomy at the proper time will prevent major complications.
Collapse
Affiliation(s)
- O Fathy
- Gastroenterology Surgery Centre, Mansoura University, Gehan Street, Mansoura, Egypt
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Wahab MA, Sultan A, Elgwalby N, Fathy O, Abo zied M, Aboelenen A, Fouad A, Abd alla T, Kandel T, Elshobary M, Elfiky A, el Ebidy G, Gad el Hak NG, Ezzat F. Outcome after resection of central cholangiocarcinoma: preliminary experience with 46 patients in a single center. Hepatogastroenterology 2003; 50:337-41. [PMID: 12749216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND/AIMS Despite the enormous progress in surgery the management of cholangiocarcinoma remains a problem. In this study we present our preliminary experience in the surgical treatment of central cholangiocarcinoma. METHODOLOGY Between May 1997 and December 2001, 175 patients with central cholangiocarcinoma were admitted to our center. Of the 175 patients, 54 cases subjected to surgery, the remaining 131 patients did not undergo surgery because of advanced disease, advanced liver cirrhosis and poor general condition. Forty-six patients underwent surgical excision, their mean age was 53 +/- 3 years, and male to female ratio was 74-26%. All patients presented with jaundice associated with pain (30%) or biliary stones (32%). Surgical resection of the bile duct with or without part of segment IV were done in fourteen patients and bile duct resection together with major hepatectomy had been done in the remaining 28 patients. RESULTS Hospital mortality occurred in 10.8%; the main cause of mortality was hepatic cell failure. The most common complications were hepatic cell failure that occurred in 7 cases (15%), biliary leakage in 8 cases (17%), gastrointestinal bleeding in 3 cases (6.5%) and wound infection in 3 cases (6.5%). Late complication in the form of recurrence occurred in 12 cases (29.5%). cholangitis in 8 cases (19.5%), hepatic cell failure in 5 (12%) and gastrointestinal bleeding in 2 (4.8%). At the end of the study, 19 patients (46%) were alive with mean follow-up of 16.6 +/- 9 months. The survival rate at 6, 12, 18, 24 months was 92, 82, 52, 25, 18%, respectively. Recurrence and cholangitis were found significantly higher in the group without hepatectomy than the group after hepatectomy (p < 0.0001, p < 0.0016, respectively). CONCLUSIONS From our results we can conclude that major hepatectomy with excision of the extrahepatic bile duct system and caudate lobe resection may be recommended for the surgical treatment of central cholangiocarcinoma in selected cases.
Collapse
|
31
|
Abdel-Wahab M, Sultan A, elGwalby N, Fathy O, AboElenen A, Zied MA, Fouad A, Allah TA, el-Ebiedy G, Gad-ElHak N, Elfiky A, Ezzat F. Modified pancreaticoduodenectomy: experience with 81 cases, Wahab modification. Hepatogastroenterology 2001; 48:1572-6. [PMID: 11813575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND/AIMS Now pancreaticoduodenectomy is considered a safe and acceptable line of treatment for periampullary tumors. In spite of improvements in the surgical technique it still has a high morbidity rate. In this study we introduce new technical modifications for the original procedure aiming to decrease the incidence of morbidity. METHODOLOGY Between 1994-2000, 210 pancreaticoduodenectomies were done in the Gastroenterology Center, Mansoura University, Egypt for periampullary tumor. Eighty-one of these patients were subjected to modified pancreaticoduodenectomy. They were 57 men and 34 women with a mean age of 54 (+/- 8) years. Pancreatic carcinoma represented 54%, ampullary tumor 30%, bile duct carcinoma 5% and duodenal carcinoma 1.2%. The mean operative time was 3.7 +/- 0.5 hours and mean estimated blood loss during surgery was 733 +/- 48 mL. RESULTS Hospital mortality occurred in 3.7% with an overall morbidity rate of 32%. The most common complications were delayed gastric emptying 8.9%, pancreatic fistulae 3.8%, wound infection 6.4%, biliary leakage 3.8% and bleeding 5%. The mean postoperative hospital stay was 9.4 +/- 1 days, with mean time for starting oral feeding 6 +/- 0.9 days. Late mortality occurred in 46% for the entire group with mean follow-up 22 +/- 19 months with actuarial survival for 1, 2, 3, 4, and 5 years being 80, 45, 25, 15, and 10%, respectively. CONCLUSIONS It was found that this new modification made the operation easier with shorter operative time, less blood transfusion, low incidence of morbidity and short hospital stay. Moreover, it takes the advantages of lowering the incidence of biliary gastritis, cholangitis and peptic ulcer.
Collapse
Affiliation(s)
- M Abdel-Wahab
- Gastroenterology Center, Mansoura University, Mansoura, Egypt.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abdel-Wahab M, Sultan A, el-Ghawalby A, Fathy O, el-Ebidy G, Abo-Zeid M, Aboel-Enin A, Abdallah T, Fouad A, el-Fiky A, Gadel-Hak N, Ezzat F. Is resection for large hepatocellular carcinoma in cirrhotic patients beneficial? Study of 38 cases. Hepatogastroenterology 2001; 48:757-61. [PMID: 11462920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma in cirrhotic patients generally carries a poor prognosis either due to recurrence or to postoperative morbidity or both. Several factors affect the prognosis of hepatocellular carcinoma resection as presence of cirrhosis of the liver, tumor diameter and tumor capsulation. METHODOLOGY Thirty-eight patients with large hepatocellular carcinoma greater than 5 cm with a background of cirrhotic liver were divided into two groups according to tumor diameter. Group A (n = 20) with tumors less than 10 cm in diameter, and group B (n = 18) with tumors larger than 10 cm. All patients underwent preoperative investigations including clinical laboratory tests, sonography, computed tomography, selective angiography and upper gastrointestinal endoscopy. All patients were subjected to different types of hepatic resection. RESULTS A significant difference in tumor size, capsulation, and operation time were recorded between the two groups, of patients. No significant difference was detected between both groups regarding sex, age, viral markers, pathologic features, and Child classification. Hospital mortality occurred in 5% versus 11.1% of both groups, respectively. Postoperative jaundice and ascitis occurred in 30%, 35% versus 44.4%, 72.0%, respectively (P < 0.005, P < 0.04). Late mortality occurred in 65% of patients in group A and in 77% of group B. Recurrence was detected in 42% of group A and 62% in group B. Recurrence after resection in capsulated tumors was significantly lower than in noncapsulated tumors in group A (P < 0.01), but not significant in group B. Also, survival rate in patients with capsulated tumors was significantly better in both groups (P < 0.01) than that with noncapsulated tumors. CONCLUSIONS Resection of hepatocellular carcinoma with diameter larger than 10 cm recorded bad prognosis regarding recurrence and mortality rates than tumors less than 10 cm. However, capsulated tumors gave better postoperative prognosis than noncapsulated ones.
Collapse
Affiliation(s)
- M Abdel-Wahab
- Gastroentrology Center, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abdel-Wahab M, el-Enein AA, Abou-Zeid M, el-Fiky A, Abdallah T, Fawzy M, Fouad A, Sultan A, Fathy O, el-Ebidy G, elghawalby N, Ezzat F. Hepatocellular carcinoma in Mansoura-Egypt: experience of 385 patients at a single center. Hepatogastroenterology 2000; 47:663-8. [PMID: 10919007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma is one of the commonest malignancies in the world. The two main etiological factors for hepatocellular carcinoma are cirrhosis and viral hepatitis. Although the first choice of treatment for hepatocellular carcinoma is surgical resection, most of them are unresectable at the time of diagnosis. METHODOLOGY From January 1994 to June 1999, 385 patients with hepatocellular carcinoma were presented to the Gastroenterology surgical center, Mansoura University, Egypt and subjected to similar diagnostic process. Forty-five (11.6%) of these patients (34 males and 13 females) with a mean age of 50.9 years (+/- 7.53 years) were subjected to different types of hepatic resection. RESULTS The underlying liver pathology was cirrhosis in 85%. Positive virology was found in 82.5% (HCV 61%, HBV 14.5% and combined 7%). The main presentation were asymptomatic in 144 (37.4%) patients, abdominal pain in 92 (23.9%) patients, ascites in 95 (24.6%) patients, jaundice in 53 (14%) patients and upper gastrointestinal hemorrhage in 26 (6.75%) patients. Only 45 (11.6%) were resectable, they were subjected to hepatic resection with operative mortality in 2 cases (4.4%) and with overall mortality in 29 (64.4%) cases after 48 months (32.8 +/- 19 months) of follow-up. The main causes of late mortality were recurrence in 14 (31.1%) cases, hepatic cell failure in 7 (15.5%) cases and other causes in 6 (13.3%). CONCLUSIONS Hepatocellular carcinoma is now a common malignancy in Egypt, which usually develops on top of cirrhosis of viral origin in 82%. Hepatic resection is the only method of treatment with a low resectability rate.
Collapse
|
34
|
Abdel-Wahab M, Abo-Elenein A, Fathy O, Gadel-Hak N, Elshal MF, Yaseen A, Sultan A, el-Ghawalby N, Ezzat F. Does cholecystectomy affect antral mucosa? Endoscopic, histopathologic and DNA flow cytometric study. Hepatogastroenterology 2000; 47:621-5. [PMID: 10918999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND/AIMS Although cholecystectomy is still the "gold standard" for treatment of gallstones, this operation may be followed by gastric disorders. The aim of this study is to detect the effects of cholecystectomy on gastric antral mucosa. METHODOLOGY This prospective study has been carried out on 46 patients (20 M & 26 F) with mean age 41.7 +/- 0.2 years for whom simple cholecystectomy for gallstones was decided. Prior to the operation and 1 year after, patients were subjected to the following: clinical assessment, upper gastrointestinal endoscopy, histopathology of antral mucosa, detection of H. pylori and DNA flow cytometry. RESULTS There was an increase in the number of patients presenting suggestive symptoms of reflux gastritis: patients experiencing epigastric pain increased from 8 (17.4%) to 11 (23.39%) patients, nausea increased from 6 (13%) to 12 (26.1%) patients and bilious vomiting increased from 3 (6.5%) to 11 (23.9%) patients. Mild antral gastritis increased from 20 (43.5%) to 27 (58.7%) patients. Antral gastritis and antral erosions were detected only after the operation in 8 (17.4%) and 2 (4.3%) patients, respectively. The incidence of active chronic superficial gastritis decreased from 23 (50%) to 13 (28.2%) patients while the inactive form increased from 15 (32.6%) to 23 (50%) patients. Chronic atrophic gastritis, intestinal metaplasia and dysplasia were only detected postoperatively in 2 (4.3%) patients each. There was a decrease in the incidence of H. pylori infection from 32 (69.6) to 19 (41.3%) patients. DNA aneuploid pattern increased from 1 (2.2%) to 4 (8.7%) patients and there was a significant increase of DNA index from 1.01 (+/- 0.03) to 1.03 (+/- 0.05) (P < 0.005). CONCLUSIONS Changes in clinical, endoscopic and histopathologic findings suggest that cholecystectomy may affect gastric antral mucosa due to duodenogastric reflux. Flow cytometry may be used as an objective method for detection and evaluation of postcholecystectomy reflux gastritis.
Collapse
|
35
|
Abdel-Wahab M, el-Ebidy G, Gad el-Hak N, Abou-Elenin A, Abou-Zid M, el-Ghawalby N, Sultan A, el-Fiky A, Fathy O, Ezzat F. Fundal varices: problem and management. Hepatogastroenterology 1999; 46:849-54. [PMID: 10370625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND/AIMS The pathophysiology of gastric varices may be due to generalized or segmental portal hypertension. A considerable debate has arisen regarding the role of injection sclerotherapy in the pathogenesis of gastric varices. METHODOLOGY During the period from 1987 to 1997, a total of 1686 cases with bleeding varices were presented to our center and 225 cases (13.3%) with bleeding gastric varices were diagnosed. There were 198 males and 27 females with a total mean age of 45.7 years (+/- 7.6). Primary fundal varices (FV) were found in 121 (54%) cases and secondary FV were found in 104 (46%) cases. All patients with isolated FV presented with repeated attacks of upper gastrointestinal bleeding. RESULTS The pathological diagnosis was studied in 120 cases; it was schistosomal in 8.3% of cases, non-schistosomal in 33.3% of cases, and mixed (Schistosomal with post viral cirrhosis) in 58.3% of cases. Seventy-five cases were subjected to splenectomy and gastroesophageal decongestion (SGED), 64 cases were subjected to distal splenorenal shunt (DSRS), and 86 cases were subjected to sclerotherapy. Mortality after DSRS was 7.8%, after SGED it was 12%, and after sclerotherapy it was 21%. Rebleeding was the major complication and occurred in 3% after DSRS, in 13% after SGED, and in 18% of cases after sclerotherapy. CONCLUSIONS Gastric varices are not an uncommon condition as a cause of upper gastrointestinal bleeding. Our findings support the hypothesis that gastric varices may be considered a late sequel of injection sclerotherapy, though they may also be considered as one of the pathophysiologies of generalized portal hypertension. Finally, DSRS was found to be the treatment of choice in the management of fundal varices.
Collapse
Affiliation(s)
- M Abdel-Wahab
- Gastroenterology Surgical Center, Mansoura University, Egypt
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abdel-Wahab M, Gad-Elhak N, Denewer A, El-Ebidy G, Sultan A, Abou-Elenin A, Fathy O, Abou-Zid M, El-Ghawalby N, Ezzat F. Endoscopic laser treatment of progressive dysphagia in patients with advanced esophageal carcinoma. Hepatogastroenterology 1998; 45:1509-15. [PMID: 9840095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND/AIMS The present study was designed to evaluate the treatment of malignant dysphagia by laser palliation. METHODOLOGY Between November 1994 and May 1997, 104 patients with esophageal carcinoma were subjected to endoscopic palliation with Nd-YAG laser. They were 83 men and 21 women with mean age 57+ 6.32 years. The majority of cases (94%) presented with difficulty in swallowing. Patients were treated at one-week intervals until benefit was achieved. RESULTS A tumor mass was observed in the lower third of the esophagus in 75 (72%) patients. The tumor mean length was 6 cm (range 3-10 cm). Histology revealed that 74 (71%) patients had squamous cell carcinoma and 30 (29%) patients had adenocarcinoma. Hospital mortality occurred in 6 (5.76%) cases because of esophageal perforation, fistula, or pyothorax, and late mortality occurred in 29 (27.9%) patients. Perforation occurred in 5 (4.8%). Improvement in dysphagia occurred after a mean of 3.3 (range 1-13) treatment sessions. Luminal patency allowing easy passing of the endoscope was achieved in 59 (93%) patients. Relief of symptoms and overall outcome improvement occurred in these patients in a relatively short time, there was body weight gain and an increase in serum albumin levels in 65% of patients. CONCLUSION In conclusion, control of dysphagia by laser palliation suggests that endoscopic laser therapy should not be regarded as being in competition with other treatment techniques such as surgery, radiation, chemotherapy, dilatation or stents, in contrast it plays a complementary role to these palliative modalities.
Collapse
Affiliation(s)
- M Abdel-Wahab
- Gastroenterology Surgical Center, Mansoura University, Egypt
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abdel Wahab M, el-Ebiedy G, Sultan A, el-Ghawalby N, Fathy O, Gad el-Hak N, Abo Elenin A, Abo Zid M, Ezzat F. Postcholecystectomy bile duct injuries: experience with 49 cases managed by different therapeutic modalities. Hepatogastroenterology 1996; 43:1141-7. [PMID: 8908542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIMS In this study we present our experience in the management of iatrogenic biliary injuries. Forty-nine cases with iatrogenic biliary injuries were managed in our center during the period from 1984 to 1995. MATERIAL AND METHODS Forty patients were referred from other hospitals after cholecystectomy, and 9 cases underwent the original operation in our center. Four (0.3%) of our patients after 1300 conventional cholecystectomy, and 5 (0.9%) cases after 550 laparoscopic cholecystectomy. RESULTS The injuries were recognized intraoperatively in 5 (10%) cases and were immediately repaired, 3 cases by axial anastomosis and T-tube drainage, 2 cases by hepatico-jejunostomy (Roux-en-Y). The injuries were detected in the remaining 44 patients postoperatively from one week up to 2 months, the mode of presentation was jaundice in 39 (89%) cases, biliary fistula with or without jaundice and biliary peritonitis were detected in 13 (30%) and in 4 (9%) cases respectively. Eleven (25%) cases were treated endoscopically by sphincterotomy, stent in 8 cases, dilatation and double stent in two cases, and dilatation using rigid dilators and stent in one case. The remaining 33 (75%) cases were treated surgically by hepatico-jejunostomy in 21 (64%) cases, and hepatico-duodenostomy in 12 (36%) cases. No hospital mortality occurred, but late mortality occurred in two (5%) patients after surgery due to biliary restricture with progressive cirrhosis in one case, and due to advanced colon cancer in the other case, an din one (9%) case after endoscopic treatment. We achieved 87% excellent surgical results during the period of follow-up (36 months), while 80% excellent results were achieved after endoscopic treatment. Good final results (95%, 83%) were achieved after hepatico-jejunostomy and after hepatico-duodenostomy respectively. CONCLUSION Postcholecystectomy biliary injuries present a surgical problem needing extra efforts and careful management. Hepatico-jejunostomy appears to be the procedure of choice in repairing these injuries. Immediate surgical repair of bile duct injury offers excellent results with lower morbidity rates. Endoscopic treatment may be a less invasive technique and have a role in some types of injuries, but needs more time for accurate evaluation.
Collapse
Affiliation(s)
- M Abdel Wahab
- Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | | | | | | | |
Collapse
|