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Minimal Incision Right Donor Hepatectomy: A Single Center Experience
( Adianto Nugroho ),( Hyeyoung Kim ),( Nam-joon Yi ),( Kwang-woong Lee ),( Kyung-suk Suh ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Minimizing the risk to organ donors is one of the reasons for the development of a less invasive technique. However, during the learning curve, donor morbidty and poorer graft function may be increased. This could be prevented with a step up approach, starting with a minimal incision, and with additional experiences, advancing to a total laparoscopic. The aim of this study was to evaluate our experience in minimal incision donor hepatectomy. Methods: Between January 1999 and February 2014, One thousands LDLT were performed at Seoul National University Hospital. Among them, 39 donors (3.9%) underwent minimal incision donor hepatectomy (37 right hemihepatectomy and 2 left lateral sectionectomy). We retrospectively analyze 37 minimal incision right hepatectomy, including Gasless Hand-assisted (GHA), Hybrid and Hand-assisted (HA) procedures. Results: There were 29 females and 8 males out of 37 donors, with the mean age of 25.32 ± 6.11 years old and median BMI 26.62 (17.16 - 30.26) kg/m2. Twenty patients (51.3%) had a transverse incision and 19 patients (48.7%) had an upper midline incision. Hybrid procedure was associated with a least EBL (223.50 ± 141.66), compared to GHA (282.5 ± 92,69) and HA (536.88 ± 92) [p =0.007]. There was no statistically significant difference in the length of stay of all techniques. Further analysis on the parenchymal transection technique, reveal a statistically significant difference between open and hand-assisted transection method, in terms of EBL (249.72 ± 122.77 vs. 536.88 ± 299.92, p =0.045) and Operating time (332.89 ± 106.29 vs 436.25 ±154.40, p=0.027). Intra operative and postoperative complications were found in 4 (10.8%) and 16 (43.2%) donor, respectively. Conclusions: Hybrid procedure of minimal incision right hepatectomy with laparoscopic liver mobilization continue with open liver parenchymal transection, is a safe and visible option in high volume transplantation center and should be taken into consideration when consulting a future donor.
Adianto Nugroho,Ariani Dewi Widodo,Indah Jamtani,Asri Dwi Rachmawati 대한췌장담도학회 2022 대한췌담도학회지 Vol.27 No.4
Chronic fibroinflammatory pancreatitis causes irreparable damage to the pancreatic parenchyma. This frequently results in food restrictions, painkiller addiction, and serious quality of life impairment in children. We observed a 13-year-old girl who had previously been hospitalized multiple times and had undergone acute pancreatitis arrived with excruciating abdominal pain and recurrent hematemesis. A chronic intra-pseudocyst bleed and an ampulla of Vater hemorrhage were discovered during an upper gastrointestinal endoscopy. A 3×2×1 cm pancreatic head pseudocyst was discovered on the magnetic resonance cholangiopancreatography, however the computed tomography scan revealed a pancreatic head pseudocyst, pancreatic duct stones, and substantial peripancreatic inflammation. The multidisciplinary team determined that Frey’s surgery was the most efficient method to minimize her suffering. No complications occurred during the healing phase following surgery, and two years later, neither recurrence bleeding nor abdominal pain appeared. In summary, Frey’s method is a secure and efficient intervention when applied by a multidisciplinary team.
Adrenal metastasis in sequentially developed combined hepatocellular carcinoma-cholangiocarcinoma
Adianto Nugroho,Kwang-Woong Lee,Kyung-Bun Lee,Hyo-Shin Kim,Hyeyoung Kim,Nam-Joon Yi,Kyung-Suk Suh 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.3
The incidence of combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CC) in a single patient accounts for only 0.4 to 14% of all primary liver cancer. However, the prognosis of its intrahepatic cholangiocarcinoma (ICC) component is poor. We experienced a unique case of a sequentially developed cHCC-CC with adrenal metastasis as the primary presentation and a hidden primary hepatocellular carcinoma. A 65-year-old female with a history of jaundice and abdominal discomfort was diagnosed with S4 ICC measuring 5 cm in diameter, and characterized histologically as papillary adenocarcinoma with intraductal growth, but without any evidence of malignant hepatocyte. S4 segmentectomy with hepaticojejunostomy revealed no additional masses. A follow-up CT scan 3 months after surgery showed a right adrenal mass with markedly increased serum AFP (4950 ng/mL), which was treated with right adrenalectomy. Histopathology revealed a metastatic hepatocellular carcinoma testing positive for AFP, glypican-3, and hepatocytes, but negative for CD-10, inhibin-, EMA, S-100, and cytokeratin-7. Serum AFP level immediately plummeted to 4.1 ng/mL upon adrenal mass removal. A recurrent S7 liver mass was suspected 1 year later with serum AFP value of 7.6 ng/mL, and characteristic CT imaging of HCC. TACE was performed with good response. Adrenal metastasis may manifest as the primary focus of hepatocellular carcinoma in sequentially developed cHCC-CC patients with hidden primary HCC. cHCC-CC should be considered in the differential diagnosis of cholangiocarcinoma with elevated AFP.
Atypical Presentation of Cat-Scratch Disease Mimicking Malignancy: A Case Report
Renandha Septaryan Yustira,Adianto Nugroho,Renaningtyas Tambun,Ivana Dewi Mulyanto,Esther Eunike,Kenny Wijaya Sutanto 대한췌장담도학회 2024 대한췌담도학회지 Vol.29 No.1
Cat-scratch disease (CSD) is a bacterial infection which primarily transmitted to humans through scratches, bites, or licks from infected cats. Even though CSD is generally a mild condition, atypical symptoms may appear and must be distinguished from other diseases. We encountered a 57-year-old woman who presented with intermittent pain in the right upper quadrant and epigastric part of the abdomen, and had lost 11 kg within a few months. She never had a cat and did not recall being scratched by a cat. Radiologic examinations strongly suggest a malignant bile duct tumor, thus liver resection was done. However, the result of histopathology was a CSD. At follow-up, the patient was stable and also showed improvement in her general condition. Hence, proper preoperative examinations of the patients are crucial in order to avoid excessive or inadequate treatment.
( Fang Taishi ),( Hong Suk Kyun ),( Lee Kwang-woong ),( Yoon Kyung Chul ),( Kim Hyo-sin ),( Nugroho Adianto ),( Murokawa Takahiro ),( Kim Hyeyoung ),( Yi Nam-joon ),( Suh Kyung-suk ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Mycophenolate mofetil is the most common auxiliary immunosuppressant after liver transplantation to relieve calcineurin inhibitor related complications. There is one type of Cellcept<sup>®</sup> available, but Myrept<sup>®</sup> produced by Chong Kun Dang Company in Korea is available as 500 mg tablet as well as 250 mg capsule. However, there has been no clinical study to assess the feasibility of this generic product. Therefore, we aimed to evaluate the feasibility, cost-effectiveness, and convenience of Myrept<sup>®</sup> 500 mg tablet in recipients after liver transplantation. Methods: A 24 week, phase 4, single center, open-label, non-comparative study was employed. A total of 50 patients were recruited. Acute rejection, changes in blood chemistry, white blood cell count, renal function, adverse drug reaction and other characteristics of the patients were recorded for 24 weeks Results: All enrolled patients and their grafts were survived within 24 weeks. Mean GFR was 119.61 ± 76.52 ml/min at beginning of the study and reached 85.20 ± 23.70 ml/min after 24 weeks and showed a significant decrease overall (p < 0.001).Nine patients (18.75%) had adverse drug reactions which had been commonly reported in other Mycophenolate mofetil generic products, and there was no serious one. These adverse reactions included gastrointestinal problems (nausea, vomiting, and abdominal discomfort), laboratory abnormality (mild increase of aspartate or alanine aminotransferase). The size of Myrept<sup>®</sup> 500 mg tablet is smaller than Myrept<sup>®</sup> 250 mg capsule (17.1 x 7.1 x 6.5 mm vs. 19.18 x 7.23 x 6.40 mm). When comparing the same dose, the cost is less expensive (1,344 Korean won vs. 1,792 Korean won for 500 mg). Conclusions: In conclusion, Myrept<sup>®</sup> 500 mg tablet is feasible, cost-effective, and convenient in recipients after liver transplantation.