ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER.

Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases.

RE-HEPATECTOMY MEANS MORE MORBIDITY? A MULTICENTRIC ANALYSIS.

Aim: Colorectal cancer generally metastasizes to the liver. Surgical resection of liver metastasis, which is associated with systemic chemotherapy, is potentially curative, but many patients will present recurrence. In selected patients, repeated hepatectomy is feasible and improves overall survival.

Undifferentiated Embryonal Sarcoma of the Liver Involving All Major Hepatic Veins Treated by Left Extended Trisectionectomy.

Introduction: Over the past few years, liver surgery has been in constant evolution and gained many improvements that helped surgeons push limits further. A complex procedure such as left extended trisectionectomy, as described by Makuuchi in 1987, may be performed in selected cases.

Aim: Describe a case of successful resection of a huge bilobar liver sarcoma involving all hepatic veins from a young female patient, in which the blood outflow was preserved through an inferior right hepatic vein, leaving only segment 6 as liver remnant.

Thoracic epidural analgesia and immediate extubation for less than 10 kg infants undergoing living donor liver transplantation: A report of two successful cases.

Background: Perioperative pain management in small infants weighing <10 kg undergoing liver transplantation is challenging. The use of TEA in this setting has not been reported, as well as its potential role to facilitate IE, ie, in the OR.

Methods: We describe here the use of TEA in two small infants who had IE after a LDLT procedure.

EXTERNAL PRINGLE MANEUVER IN LAPAROSCOPIC LIVER RESECTION: A SAFE, CHEAP AND REPRODUCIBLE WAY TO PERFORM IT.

Background: Tourniquet for right hepatectomy tightened and secured with forceps (arrow). Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern.

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.

Variation in complications and mortality following ALPPS at early-adopting centers.

Background: Various, often conflicting, estimates for post-operative morbidity and mortality following ALPPS have been reported in the literature, suggesting that considerable center-level variation exists. Some of this variation may be related to center volume and experience.

Methods: Using data from seventeen centers who were early adopters of the ALPPS technique, we estimated the variation, by center, in standardized 90-day mortality and comprehensive complication index (CCI) for patients treated between 2012 and 2018.

ALPPS as a salvage procedure after insufficient future liver remnant hypertrophy following portal vein occlusion.

Background: A minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a "Salvage Procedure" for PVO failure.

Monosegmental ALPPS after Bilateral Hepatectomy.

Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) has emerged as an alternative for patients with bilobar colorectal liver metastasis and a small future liver remnant (FLR). In cases of extensive disease, ALPPS can be performed, leaving only one segment of the liver as FLR. We describe a case of monosegmental ALPPS using segment 4 as FLR.

Right gastroepiploic artery as an alternative for arterial reconstruction in living donor liver transplantation.

Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction.

Portal vein embolization using an adapted hysterosalpingography catheter.

Background: Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications.

Aim: To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route.

Methods: Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter.

Living Donor Liver Transplantation for Caroli's Disease: A Report of Two Cases.

Caroli's disease (CD) is a rare autosomal recessive disorder characterized by intrahepatic cystic dilatation of the bile ducts. Patients with bilobar or progressive disease may require orthotopic liver transplantation (OLT). In the MELD era, living donor liver transplantation (LDLT) raised as the ultimate treatment option for these patients, once their MELD score is usually low.

Inflammatory pseudotumor of the liver complicated by lung necrosis and pleural empyema: a case report.

Inflammatory pseudotumor of the liver (IPTL) is a rare condition, but an important differential diagnosis of hepatic space-occupying lesions. It may regress spontaneously and mimic other liver tumors. Complications are usually intrahepatic.

Is there any difference between right hepatectomy and left lateral sectionectomy for living donors? as much you cut, as much you hurt?

Background: The worldwide rising demand for cadaveric donors in liver transplantation is an important incentive for the development of alternative transplantation options, such as living donors. A precise evaluation of surgical complications is, therefore, considered to be an important issue in this setting.

Aim: Present a retrospective analysis of 126 living donors hepatectomies undertaken at our centre.

Methylene blue used as a bridge to liver transplantation postoperative recovery: a case report.

Hepatopulmonary syndrome is defined as a triad of liver disease, arterial hypoxemia, and intrapulmonary vascular dilatation. The clinical hallmark of this disorder is the impairment of pulmonary gas exchange, not necessarily correlated with the severity of the underlying liver disease. Liver transplantation (OLT) is the only definitive treatment for this syndrome.

Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 kg, without microscope use.

Arterial reconstructions are pivotal, particularly in pediatric LDLT. We describe microsurgical reconstruction technique with 6x loupes and the clinical course of the first 23 less than 10 kg recipients in an initial LDLT program at a developing country. From March 2002 to October 2008, 286 liver transplantation were performed in 279 patients at our unit.

Protamine sulphate for treatment of severe post-reperfusion coagulopathy in pediatric liver transplantation.

In this case report, we describe a child with biliary atresia who underwent a living LDLT and developed severe coagulopathy after reperfusion of the graft. The ROTEM analysis strongly suggested the presence of either a heparin effect or severe deficiency of coagulation factors. The former diagnosis was supported by a subsequent in-vitro HEPTEM.

Selection of donors for living donor liver transplantation in a single center of a developing country: lessons learned from the first 100 cases.

The selection of donors for living donor liver transplantation (LDLT) is one of the most important features in this kind of surgery. The aim of this study is to describe our initial experience in the donor evaluation process. From December 2001 to January 2005, 104 donors were evaluated for 70 recipients (65 potential donors were evaluated for 39 adult recipients, and 39 donors for 31 pediatric recipients).