Excellent outcome of living donor liver transplantation in patients with hepatopulmonary syndrome: a single centre experience.

Introduction: Hepatopulmonary syndrome (HPS) worsens the prognosis of cirrhosis and liver transplantation is only definitive treatment. There is paucity of data about role of living donor liver transplantation (LDLT) in HPS.

Methods: Fourteen patients with HPS and cirrhosis who underwent LDLT were prospectively included.

Liver Transplantation for HCC: A Review.

Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease or cirrhosis. Liver transplantation for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Limitations in organ availability, necessitate stringent selection of patients who would likely to derive most benefit.

Small bowel enterocutaneous fistulae: the merits of early surgery.

Background: The treatment of patients with small bowel enterocutaneous fistulas is complex and a challenge for every surgeon. The mortality and morbidity associated with only conservative management is often high and expensive because most patients cannot afford prolonged parenteral nutrition which itself carries a high incidence of complications. Although operations are difficult if performed early they may be lifesaving in our situation.

Use of banked cryopreserved veins from explanted recipient livers in living donor liver transplantation.

Background: In living donor liver transplantation, variations in donor vascular anatomy, recipient portal vein thrombosis, short donor vessel length, and reconstitution of the anterior sector outflow in right lobe grafts often make complex and innovative vascular reconstructions necessary, which require the use of extension vascular conduits. Commonly used grafts are cryopreserved vessels from deceased donors, or obtained from the recipient or the live liver donor. Faced with paucity of deceased donor vessels, and to avoid the use of live donor veins in patients with malignancy or unusable intrahepatic veins, we have started using cryopreserved veins harvested from explanted livers of other recipients of the same blood group who had no transmissible infection or intrahepatic malignancy.

Sinistral portal hypertension. A case report.

Sinistral portal hypertension is a clinical syndrome of gastric variceal hemorrhage in the setting of splenic vein thrombosis due to a primary pancreatic pathology. The distinguishing features from other forms of portal hypertension are preserved liver function and a patent extrahepatic portal vein. The important causes include acute and chronic pancreatitis, pancreatic pseudocysts and pancreatic carcinomas.

Management protocol for acute gastrointestinal bleeding.

Gastro-intestinal haemorrhage is not uncommon and is manifested as haematemesis, melaena or haematochezia. The first step is to resuscitate the patient if necessary and then proceed to make a diagnosis as well as divide patients into high and low-risk groups after taking a good history and performing a physical examination especially to detect the presence of an enlarged spleen. Then one should proceed with an endoscopy and other investigations chosen carefully for their usefulness.

Issues in management of pancreatic pseudocysts.

Pancreatic pseudocysts (PPs) comprise more than 80% of the cystic lesions of the pancreas and cause complications in 7-25% of patients with pancreatitis or pancreatic trauma. The first step in the management of PPs is to exclude a cystic tumor. A history of pancreatitis, no septation, solid components or mural calcification on CT scan and high amylase content at aspiration favor a diagnosis of PP.

Complicated colonic diverticulosis: surgical perspective from an Indian Centre.

Introduction: Colonic diverticulosis was previously uncommon in India but its incidence seems to have increased recently. Patients with the disease in developing countries are also underdiagnosed and are therefore more likely to present with complications needing operation. However there is a paucity of surgical data on the condition.