Laparoscopic anatomic liver resection in the era of fluorescence imaging systems

Catherine TEH 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.-

PE-170: Body Mass Index as a Predictor of Severity of Fibrosis from a Tertiary Liver Center in the Philippines

( Angelo Lozada ),( Catherine Teh ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: A variety of clinical and biochemical factors have been proposed to predict liver fibrosis. Some of these entail high cost and are impractical in the 3rd world setting. Thus, the aim of this study is to determine of body mass index (BMI) predectis the severity of liver fibrosis as assessed by Transient Elastography (TE, Fibroscan®), seen in a local liver clinic. Methods: From 3207 patients seen at the Makati Medical Center Liver Clinic from Jan 2010 to Feb 2016 with various liver diseases, a total of 388 were enrolled into the study. Initial BMI and liver stiffness measurements (LSM) were obtained and subsequently followed up after patient education about lifestyle modification. Results: Out of the 388 patients studied, the ratio of males to females was 1:1. The mean age was 53.27±12.3 years. The most common indication for TE was a diagnosis of non-alcoholic fatty liver disease (NAFLD) at 56.7%; followed by mixed liver disease, 39.5%; Hepatitis B, 3%; and Hepatitis C, 0.7%. Subsequent follow up showed no change in patients’ BMI (26.7±3.68 vs 26.5±3.52, P>0.05). Likewise there was a positive correlation between the BMI and the LSM (P<0.05). Conclusions: Our results showed that BMI may be a useful predictor of severity of fibrosis in patients with liver disease in the 3rd world setting where cost of fibrosis testing maybe prohibitive. This study likewise shows that patient education is a key factor in the reversal of fibrosis and that efforts to emphasize this are lacking.

HCC : PE-079 ; Two cases of hepatic carcinoma post-hepatic resection presenting with chylous ascites: a case report

( Billy James Uy ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Chylous ascites is a rare phenomenon characterized by milky turbid ascitic fluid usually caused by ruptured lymphatics associated with a variety of causes. The main causes are usually malignant tumors, hepatic cirrhosis and tuberculosis. This case report aims to present two cases of chylous ascites post-hepatic resection that presented with significantly different outcomes. Presentation: Case No. 1. A 53 year old male alcoholic drinker presented with a right hepatic mass during appendectomy. Segmental (segment VII) hepatic resection revealed hepatic carcinoma with a cirrhotic background. One year after, CT scan revealed left hepatic mass wherein patient underwent left lateral segmentectomy. A year after the 2nd hepatic resection, patient developed globular abdomen where paracentesis revealed the presence of chylous ascites. Patient’s ascites was refractory to diuretics, octreotide and other medical management leading to his eventual demise. Case No. 2. A 48 year male diagnosed with hepatitis B presented with a 19 cm liver tumor involving segment V, VII and VII infiltrating the pleura and right lower lung lobe. CT scan revealed multiple lymphadenopathy on the portal and suprapancreatic area. Right hemihepatectomy with enbloc resection of the diaphragm, left lower lung resection and radical lymph node dissection was done. Patient developed chylous ascites 8 days post-op but eventually subsided with dietary fat restriction and intravenous octretide for 7 days. Patient recovered well. Conclusion: Hepatic resection of hepatocellular carcinoma could lead to the development of chylous ascites. However, the presence of liver cirrhosis could have led to the development of liver failure leading to intractable ascites that was refractory to treatment.

HCC : PE-079 ; Two cases of hepatic carcinoma post-hepatic resection presenting with chylous ascites: a case report

( Billy James Uy ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Chylous ascites is a rare phenomenon characterized by milky turbid ascitic fluid usually caused by ruptured lymphatics associated with a variety of causes. The main causes are usually malignant tumors, hepatic cirrhosis and tuberculosis. This case report aims to present two cases of chylous ascites post-hepatic resection that presented with significantly different outcomes. Presentation: Case No. 1. A 53 year old male alcoholic drinker presented with a right hepatic mass during appendectomy. Segmental (segment VII) hepatic resection revealed hepatic carcinoma with a cirrhotic background. One year after, CT scan revealed left hepatic mass wherein patient underwent left lateral segmentectomy. A year after the 2nd hepatic resection, patient developed globular abdomen where paracentesis revealed the presence of chylous ascites. Patient`s ascites was refractory to diuretics, octreotide and other medical management leading to his eventual demise. Case No. 2. A 48 year male diagnosed with hepatitis B presented with a 19 cm liver tumor involving segment V, VII and VII infiltrating the pleura and right lower lung lobe. CT scan revealed multiple lymphadenopathy on the portal and suprapancreatic area. Right hemihepatectomy with enbloc resection of the diaphragm, left lower lung resection and radical lymph node dissection was done. Patient developed chylous ascites 8 days post-op but eventually subsided with dietary fat restriction and intravenous octretide for 7 days. Patient recovered well. Conclusion: Hepatic resection of hepatocellular carcinoma could lead to the development of chylous ascites. However, the presence of liver cirrhosis could have led to the development of liver failure leading to intractable ascites that was refractory to treatment.

LT, Others : PE-130 ; Laser lithotripsy in a diffucult case of hepatocholedocholithiasis with distal common bile duct stricture done at the national kidney and transplant institute: a case report

( Billy James Uy ),( Kristine Trocio ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Introduction: The presence of intrahepatic lithiasis is an operative dilemma for surgeons. Not all cases are amenable to endoscopic retrograde cholangiography (ERCP) extraction, and intraoperative biliary extraction is fraught with difficulties. A usual option is to insert a t-tube to allow percutaneous choledoscope extraction post-operatively. Hepatic resection is also another option but has a higher morbidity. Recent studies have shown the applicability of laser lithotripsy in the removal of intrahepatic stones. Methods: We report a case of intrahepatic lithiasis not amenable to ERCP and intraoperative biliary extraction that was done in a center specialized in urologic cases. Summary: A 52 year old male presented colicky abdominal pain where ultrasound showed calculous cholecystitis. Patient was initially treated with antibiotics but developed jaundice with acolic stools after a week. Patient was admitted and repeat ultrasound revealed calculous cholecystitis with suspicious obstructing calculus in the proximal CBD, distal CBD stricture was noted. Ductal dilatation and stone extraction failed, hence a F10 stent was inserted and scheduled for surgery. Intraoperative ultrasound revealed multiple stones in the CBD and was extracted through a choledochotomy. A 0.5 cm stone was impacted in the secondary radicles of the right hepatic duct. A nephroscope was inserted and stone basket extraction done but failed. Laser lithotripsy was used to break the stone into smaller fragments, flushed out and extracted more proximally. A roux-en-y hepaticojejunostomy was done to bypass the distal CBD stricture. Patient recovered and was eventually discharged. Conclusion: In intrahepatic stones that have failed ERCP and biliary extraction, the combination of a surgical enterotomy, biliary endoscopy, and laser lithotripsy could provide a viable option for stone removal. However, for centers not specialized in hepatobiliary surgery with lack of equipment, this could pose a significant challenge on its applicability.

LT, Others : PE-130 ; Laser lithotripsy in a diffucult case of hepatocholedocholithiasis with distal common bile duct stricture done at the national kidney and transplant institute: a case report

( Billy James Uy ),( Kristine Trocio ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Introduction: The presence of intrahepatic lithiasis is an operative dilemma for surgeons. Not all cases are amenable to endoscopic retrograde cholangiography (ERCP) extraction, and intraoperative biliary extraction is fraught with difficulties. A usual option is to insert a t-tube to allow percutaneous choledoscope extraction post-operatively. Hepatic resection is also another option but has a higher morbidity. Recent studies have shown the applicability of laser lithotripsy in the removal of intrahepatic stones. Methods: We report a case of intrahepatic lithiasis not amenable to ERCP and intraoperative biliary extraction that was done in a center specialized in urologic cases. Summary: A 52 year old male presented colicky abdominal pain where ultrasound showed calculous cholecystitis. Patient was initially treated with antibiotics but developed jaundice with acolic stools after a week. Patient was admitted and repeat ultrasound revealed calculous cholecystitis with suspicious obstructing calculus in the proximal CBD, distal CBD stricture was noted. Ductal dilatation and stone extraction failed, hence a F10 stent was inserted and scheduled for surgery. Intraoperative ultrasound revealed multiple stones in the CBD and was extracted through a choledochotomy. A 0.5 cm stone was impacted in the secondary radicles of the right hepatic duct. A nephroscope was inserted and stone basket extraction done but failed. Laser lithotripsy was used to break the stone into smaller fragments, flushed out and extracted more proximally. A roux-en-y hepaticojejunostomy was done to bypass the distal CBD stricture. Patient recovered and was eventually discharged. Conclusion: In intrahepatic stones that have failed ERCP and biliary extraction, the combination of a surgical enterotomy, biliary endoscopy, and laser lithotripsy could provide a viable option for stone removal. However, for centers not specialized in hepatobiliary surgery with lack of equipment, this could pose a significant challenge on its applicability.