Extensive Adhesions in Living Donor Liver Transplantation: A Retrospective Analysis
Autor: | Wei-Feng Li, Chee-Chien Yong, Yu-Hung Lin, Chih-Chi Wang, Allan M. Concejero, Tsan-Shiun Lin, Hirak Pahari, Chao-Long Chen, Chih-Che Lin, Ting-Lung Lin, Bruno Jawan, Yueh-Wei Liu |
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Rok vydání: | 2015 |
Předmět: |
Adult
medicine.medical_specialty Blood transfusion medicine.medical_treatment Operative Time Blood Loss Surgical Tissue Adhesions 030230 surgery Liver transplantation 03 medical and health sciences 0302 clinical medicine Living Donors medicine Hepatectomy Humans Blood Transfusion Child Survival rate Retrospective Studies business.industry Cold Ischemia Age Factors Retrospective cohort study Liver Transplantation Cardiac surgery Surgery Survival Rate Treatment Outcome Intestinal Perforation Cardiothoracic surgery Case-Control Studies 030220 oncology & carcinogenesis business Abdominal surgery |
Zdroj: | World Journal of Surgery. 40:427-432 |
ISSN: | 1432-2323 0364-2313 |
DOI: | 10.1007/s00268-015-3219-x |
Popis: | Adhesions are abnormal fibrous bands of scar tissue between internal organs and tissues. With respect to recipient hepatectomy in living donor liver transplantation (LDLT), we defined extensive adhesions as adhesions in at least two separate locations that required more than 5 % of the total surgical time to lyse. We aimed to identify the etiology and consequences of this preventable burden. A simple retrospective case–control study of all cases with extensive adhesions from August 2011 to September 2014 matched by age, sex, and diagnosis at surgery. A total of 380 cases were studied. Thirty-eight and five patients had extensive adhesions from surgical and non-surgical causes, respectively. The incidence and complications in pediatric patients were far less than in adults. In the adult group, the mean operative time was increased by 75 min (12.3 %) and blood loss by 2.5 L.The incidence of bowel perforation and biliary infections were increased in adults, while there was no significant difference in the rate of ascitic or wound infections. The 1-year survival was slightly less (92 %) than the control group (100 %). The most common cause of extensive adhesions at LDLT was prior liver resection. Extensive adhesions caused increased morbidity by increased blood loss, transfusion requirements, and increased cold ischemia time. There is also a higher risk of bowel perforation during enterolysis. The use of commercially available barrier techniques is advisable in adults at high risk of developing adhesions with a possibility of liver transplantation, such as liver resection for HCC. |
Databáze: | OpenAIRE |
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