[Updates in General Management and Frequent Complications Following Adult Liver Transplant].

Liver transplantation (LT) is a cost-effective therapy for advanced liver disease. Although LT significantly improves long-term survival, it requires strict control of immunosuppressants and their potential complications. Several available immunosuppressive drugs include glucocorticoids, calcineurin inhibitors, mycophenolate, mTOR inhibitors, and anti-CD25 antibodies.

[Pancreatoduodenectomy in Octogenarian Patients and the Need for Standardized Evaluation].

Unlabelled: Pancreatoduodenectomy represents the only curative alternative in patients with periampullary tumors, currently with acceptable morbidity and mortality rates. However, there is little evidence in octogenarian patients.

Aim: To describe the experience of octogenarian patients undergoing pancreatoduodenectomy for tumors of the periampullary area at the Hospital Clínico de la Pontificia Universidad Católica de Chile.

Central Pancreatectomy as a Surgical Alternative for Parenchyma Preservation.

Pancreatoduodenectomy and distal pancreatectomy are standard treatments for various pancreatic pathologies. These procedures involve radical resection and a significant loss of pancreatic tissue, which can lead to exocrine and/or endocrine pancreatic insufficiency. In selected cases of benign tumors or those with low malignant potential, central pancreatectomy can be performed with acceptable morbidity and mortality rates.

Pushing the Boundaries of Minimally Invasive Surgery: Fully Laparoscopic Left Hepatectomy Extended to Segment 8 for Bilobar Colorectal Liver Metastases.

The surgical management of hepatic metastases from colorectal cancer may range from segmental resections to major or extended hepatectomies. The aim is to achieve complete removal of metastatic lesions while preserving adequate liver function. We present the case of a 42-year-old male patient with a history of glucose intolerance who presented with altered bowel movements and abdominal pain.

Radical Laparoscopic Pericystectomy of a Giant Hepatic Hydatid Cyst.

Hydatidosis is an endemic zoonotic disease with an uneven geographical distribution due to the varying abundance of its intermediate hosts, primarily cattle, and sheep in different regions, leading to a higher concentration of cases in livestock areas. Despite advancements in medical treatment and interventional radiology, surgery remains the treatment of choice for patients with hepatic hydatid cysts (HHC). Over the past decade, laparoscopic management of HHC has gained popularity; however, controversies persist regarding optimal patient selection, surgical techniques, and follow-up protocols.

ADULT-TO-PEDIATRIC LIVING DONOR LIVER TRANSPLANT IN RECIPIENTS >20 KG: A CASE SERIES OF FULL LEFT LOBE GRAFTS.

Background: Chile presents one of the lowest organ donation rates, resulting in pediatric liver waitlist mortality rates up to 38.1%. Live donor liver transplantation is one of the main alternatives to decrease waitlist mortality, mostly utilized in our country for small children up to 20 kg.

[Portal vein embolization prior to major hepatectomy: A multidisciplinary approach for advanced liver tumors in Chile].

Background: One of the main limitations to achieving a complete tumor resection in patients with technically resectable liver tumors is the presence of a small future liver remnant (FLR). Portal vein embolization (PVE) allows hypertrophy of the non-embolized lobe, reducing the risk of postoperative liver failure.

Aim: To describe the experience of portal embolization prior to hepatectomy and its effectiveness in converting advanced unresectable liver tumors into resectable tumors.

Type I choledochal cyst. Total laparoscopic resection and Roux-en-Y reconstruction to two separated ducts.

A choledochal cyst is a rare condition that requires surgical treatment to prevent complications, such as obstructive jaundice, cyst rupture, cholangitis, and the risk of malignancy. Complete cyst excision is considered the best option, as it reduces the risk of inflammation and the development of cholangiocarcinoma. Therefore, cholecystectomy and complete cyst resection followed by reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice.

Portosystemic shunt surgery for severe portal hypertension due to portal thrombosis after bariatric surgery.

Portal vein thrombosis is a rare complication after laparoscopic sleeve gastrectomy, a widely performed bariatric surgery procedure. Occasionally, the development of portal vein thrombosis can progress to more severe conditions, including portal hypertension and cavernomatosis, thereby presenting a complex and challenging clinical scenario. The management of such complications often requires careful consideration; however, surgical intervention in the form of a splenorenal shunt is an exceptional indication.

Roux-en-Y biliary reconstruction as a definitive treatment for serious complications of portal biliopathy. Case series.

Introduction And Importance: Portal biliopathy (PB) is an abnormality of the biliary tree wall due to extrahepatic portal hypertension. Among the complications of portal biliopathy are digestive bleeding, jaundice, and cholangitis. Surgical treatment is an exception when medical management is not possible.

Liver resection for hepatolithiasis: A multicenter experience in Latin America.

Background: Hepatolithiasis is a prevalent disease in Asia but rare in Western countries. An increasing number of cases have been reported in Latin America. Liver resection has been proposed as a definitive treatment for complete stone clearance.

Right Lobe Liver Donation After Bariatric Surgery. A Case Series of 4 Living Donors.

Background: The increasing prevalence of obesity and need for bariatric surgery as well as the expanding use of living donors for liver transplantation means that potential donors could present with this surgical history. We present 4 cases of liver donors with previous bariatric surgery in our living donor liver transplant program.

Methods: A retrospective descriptive analysis of patients with a bariatric surgery history who underwent right hepatectomy in our living donor liver transplant program is presented.

A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program.

Background: Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents' exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential.

Pure laparoscopic living donor right hepatectomy (with video).

Only a few centers in the world perform pure laparoscopic right hepatectomy for adult-to-adult living donor liver transplantation. In this procedure, right lobe donation is mostly preferred in view of the higher graft volume usually needed for the recipient. In the area, laparoscopic surgery has had a minor development given the greater technical difficulty and risks for both donor and preservation of the graft.

Fully laparoscopic pancreaticojejunostomy, Puestow procedure (with video).

Chronic pancreatitis usually requires medical treatment and, in rare cases, surgical intervention. The most frequent cause of consultation is chronic pain that is difficult to manage, and therapeutic options such as endoscopy can resolve most problems without surgery. However, when these options fail, surgical management is necessary.

Validity Argument for a Simulation-Based Objective Structured Clinical Examination Scenario for Evaluation of Surgical Skills in Trauma.

Background: Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have diminished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings.

SELF-CONFIDENCE ON ACQUIRED SURGICAL SKILLS TO DEAL WITH SEVERE TRAUMA PATIENTS IN RECENTLY GRADUATED SURGEONS.

Background: Level of competence by procedure. Trauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old.

Achievement of effective cardiopulmonary trauma surgical skills training throughout the incorporation of a low-cost and easy to implement pulsatile simulation model.

Objectives: . In the last decade, concern regarding the preparedness of general surgery graduates to effectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited.

Severe case of post cholecystectomy vasculobiliary injury successfully treated by right hepatectomy with a jump graft to the remaining left hepatic lobe.

Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones.

Smartphone application supplements laparoscopic training through simulation by reducing the need for feedback from expert tutors.

Background: Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. We present an app to guide students during advanced laparoscopy simulation training and evaluate its effect on training.

BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA.

Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis.

Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study.

Background: In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking.

Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer.

Background: The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias.

Methods: This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017.