First Expiriens of Living Donor Liver Transplantation

( Zhanadil Almyrzauly ),( Myltykbay Rysmakhanov ),( Yerlansul-tangereev ),( Bazylbek Zhakiev ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Presents to analyze of first experience of Living Donor LiverTransplantation (LDLT) at Aktobe Medical Center, in the two-year period. LDLT were performed with the participation of specialists from Korea. Methods: LDLT were done after the candidates (living donor and recipient) were : valuated following our practices guidelines. After donor right hepatectomies TNK solution with heparine was used for graft perfusion. “Middle hepatic vein” reconstruction performed by synthetic vascular graft. During recipient hepatectomy used “High Hillary Dissection” method. Right liver graft implantation made as standard technique. Before portal reperfusion, liver graft washed by 5% Albumine solution. Immunosupressive therapy in all patients included three components (CNI + MMF + Steroid) with introduction of Basiliximab (first and fourth postoperative day). Results: In our Center during 2016-2017 years performed 9 living donor liver transplantation. Our donors age were between 22 and 54 years. In all cases removed right lobe. From 3 donors we used 3D-laparoscopic right hepatectomy. All donors discharged at 7th-9th day after operation. Recipient’s characteristics shown in Tab.1. Died 2 recipient in late postoperative period: after infection complications (cholangiogenic abscess with sepsis and chronic rejection). Conclusions: LDLT gives a big chance to survive for patients : ith end-stage liver disease in Kazakhstan. Our transplant program needs to be gain experience, particularly with respect to donor selection, recipient preoperative preparing.

Our First Experience of Living Donor Liver Transplantation

( Zhanadil Almyrzauly ),( Ermakhan Assylkhanuly ),( Erlan Sultangereev ),( Bazylbek Zhakiev ),( Asset Kaliev ),( K-w Lee ),( Myltykbay Rysmakhanov ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Presents to analyze of first experience of Living Donor Liver Transplantation (LDLT) at Aktobe Regional Hospital, Kazakhstan, in the one-year period. LDLT were performed with the participation of specialists from SHUH. Methods: LDLT were done after the candidates (living donor and recipient) were evaluated following our practices guidelines. After donor right hepatectomies TNK solution with heparine was used for graft perfusion. “Middle hepatic vein” reconstruction performed by synthetic vascular graft. During recipient hepatectomy used “High Hillary Dissection” method. Right liver graft implantation made as standard technique. Before portal reperfusion, liver graft washed by 5% Albumine solution. Immunosupressive therapy in all patients included three components (CNI + MMF + Steroid) with introduction of intravenous Basiliximab (first and fourth postoperative day). Results: In our Hospital performed 7 living donor liver transplantation. Our donors age were between 22 and 48 years. In all cases removed right lobe. From 2 donors we used 3D-laparoscopic right hepatectomy. All donors discharged at 7th day after operation. There were no complication on liver donors. Recipient’s characteristics shown in Tab.1. Died one recipient, after infection complications (cholangiogenic abscess, sepsis). Conclusions: LDLT gives a chance to survive for patients with end-stage liver disease in Kazakhstan. Our transplant program needs to be gain experience, particularly with respect to donor selection, recipient preoperative preparing. Table 1. Recipients.

Laparoscopic Cholecystectomy Complications: Single Center Experiences

( Aset Yelemesov ),( Erlan Sultangereev ),( Galymzhan Aubakirov ),( Zhazylbek Abdi ),( Bazylbek Zhakiev ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Aim. Cholelithyasis - one of the worldwide disease and it occurs in 10% of the population in the world. 95-98% of all this operations perfume by laparoscopic method. According reports after laparoscopic cholecystectomy (LCE) complications observed at 1% to 8,5%. The aim is to evaluate the complications of laparoscopic cholecystectomy. Methods: Materials and methods. 1412 LCE operations were analyzed, which performed in period 2009-2016. Among them 914 patients (64,7%) had GS with acute cholecystitis, 498 (45,3%) - chronic cholecystitis. Average age was 49,5±0,37 year. Woman - 81,4% (n=1150), man - 18,6% (n=262). Results: Intraoperative and early postoperative complications occurred in 31 (2,2%) patients. The conversion is made in 46 (3,26%) cases. Cause of conversions was: adhesive infiltrative process of hepatoduodenal ligament - 34 cases (73,9%), common bile duct injure - 5 (10,8%), liver abscess detection - 1 (2,1%), atypical cystic artery - 1 (2,1%), massive bleeding from cystic artery - 2 (4,3%), bleeding from gallbladder bed - 2 (4,3%), duodenum wall injure - 1 (2,1%). In early postoperative period observed following complications: bile leakage - in 9 patients (in 5 patients it stopped on their own), bleeding - 2, sub-hepatic infiltrate - 4, choleperitonitis after injure of extrahepatic bile duct - 3. Three patients had relaparoscopy due to bile leakage from cystic duct stump (1 case) and bleeding from cystic artery (2 cases). Reasons of early 4 laparotomy were postoperative bleeding - 1 patient, bile leakage - 3 cases. In three cases with bile leakage we held suturing the bile duct wall with billiary drainage. Abdominal wall wound inflammatory complications were 5-6%. One patient after LCE had pulmonary artery tromboembolism and died. Conclusions: The study of the causes of intraoperative and early postoperative complications of LCE can eliminate risk factors that contribute to development. Careful comprehensive preoperative examination to the prediction of the complexity of surgical intervention will improve immediate results of LCE.

The First Case of Pure 3D Laparoscopic Living Donor Hepatectomy in Kazakhstan

( Kyung Chul Yoon ),( Kaliev Aset ),( Zhanadil Almyrzauly ),( Yerlan-sultangereyev ),( Bazylbek Zhakiev ),( Kwang-woong Lee ),( Kyung Chul Yoon ),( Kaliev Aset ),( Zhanadil Almyrzauly ),( Bazylbek Zha 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Laparoscopic living donor hepatectomy is performed selectively in some countries because of the small sized structures and anatomic variations which requires more precise technique. In Kazakhstan about 200 cases of living donor liver transplantation were performed starting from December 2011.We now present the first case of laparoscopic living donor hepatectomy in Kazakhstan using a 3D laparoscopic device with colleagues from Seoul National University Hospital, Korea by professor KwangWoong Lee. Methods: A 23-year-old male volunteered for living donor to his older brother who had combined hepatitis B, D and C related cirrhosis without any history of antiviral treatment. The recipient age was 36 and His model for end-stage liver disease score was 22. Brief morphologic characteristics of donor and recipient were as follows: donor - height 177 cm, weight 74 kg, BMI 23.64 kg/m²standard liver volume 1348 ml; recipient - height 172 cm, weight 78 kg, BMI 26.44 kg/m², standard liver volume 1350ml.Donor graft volume was 820ml and left remnant liver volume was 32%. Results: The surgery was performed in October 2016 with 5 port insertion using an ultrasonic dissector, Cabitron Ultrasonic Aspirator, and clips. The liver was extracted via 10 cm sized suprapubic incision. V5 and V8 were reconstructed to the right hepatic vein using the PTFE graft. The Donor’s operation time was 295 minutes and estimated bleeding was 700ml. The recipient had sanguinous drain and bleeding control was performed postoperative day 1 due to bleeding from hilar plate. Both donor and recipient were discharged after 15 and 28 days and the donor was not eventful. Conclusions: 3D laparoscopic hepatectomy has been progressively developed along the past decade. High quality studies allied with high-level surgical training are required to base surgical practice and to disseminate the benefits of to many centers as possible. Future applicability of new technologies such as robot assistance and 3D surgery is still under investigation in Kazakhstan.

Laparoscopic Cholecystectomy Complications - Our Experience

( Zhanar Kaidar ),( Erlan Sultangereev ),( Galymzhan Aubakirov ),( Zhazylbek Abdin ),( Asset Elemesov ),( Bazylbek Zhakiev ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The aim is to analysis of the complications of laparoscopic cholecystectomy (LCE). Methods: Retrospectively analyzed 1412 LCE, which performed between 2009-2016. The indication to LCE was gallbladder stone (GS). 914 patients (64,7%) had GS with acute cholecystitis, 498 (45,3%) - chronic cholecystitis. Average age was 49,5±0,37 year. Woman - 81,4% (n=1150), man - 18,6% (n=262). Results: Complications occurred in 31 (2,2%) patients. The conversion was in 46 (3,26%) cases. Cause of conversions: infiltrative process of HDL - 34 cases (73,9%), bile duct injure - 5 (10,8%), liver abscess detection - 1 (2,1%), atypical cystic artery - 1 (2,1%), bleeding - 4 (8,6%), duodenum injure - 1 (2,1%). Early postoperative complications: bile leakage - 9 patients (in 5 patients stopped own), bleeding - 2, sub-hepatic infiltrate - 4, choleperitonitis - 3. Three patients had relaparoscopy due to bile leakage from cystic duct stump (1 case) and bleeding from cystic artery (2). Reasons of early 4 laparotomy were postoperative bleeding - 1 patient, bile leakage - 3 cases. Abdominal wall wound inflammatory complications were 1,9% (after LCH for acute cholecystites). After LCE 1 patient died due to pulmonary artery tromboemboly. Those, after LCE complications causes were: Inflammatory tissue infiltration in the subhepatic area with acute cholecystitis, adhesions and scarring in chronic process hinders the visualization of anatomical structures. The atypical anatomical structure of the extrahepatic bile ducts and liver vessels. Risk factors of complications include older age, obesity, long duration of GB disease. Conclusions: The study of the causes of intraoperative and early postoperative complications of LCE can eliminate risk factors that contribute to it development. Careful comprehensive preoperative examination to the prediction of the complexity of surgical intervention will improve immediate results of all LCE.