Temporary abdominal closure and delayed biliary reconstruction due to massive bleeding in patients undergoing liver transplantation: an old trick in a new indication
| Autor: | Chao-Long Chen, Tun‐Sung Huang, Chih-Chi Wang, Ting-Lung Lin, Bruno Jawan, Chee-Chien Yong, Andrzej L. Komorowski, Tsan-Shiun Lin, Wei-Feng Li, Carlos A. Millan |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Abdominal Wound Closure Techniques medicine.medical_treatment Liver transplantations Blood Loss Surgical 030230 surgery Liver transplantation 03 medical and health sciences 0302 clinical medicine Biliary tract surgical procedures medicine Humans Prospective Studies Prospective cohort study Aged Postoperative Care Hepatology business.industry Surgical hemorrhage Original Articles Middle Aged Plastic Surgery Procedures medicine.disease Abdominal wound closure techniques Portal vein thrombosis Surgery Liver Transplantation Transplantation Pneumonia Bacteremia 030211 gastroenterology & hepatology Original Article Female Bile Ducts Biliary Tract Surgical Procedures business |
| Zdroj: | Journal of Hepato-Biliary-Pancreatic Sciences |
| ISSN: | 1868-6982 1868-6974 |
| Popis: | Background Massive bleeding during liver transplantation (LT) is difficult to manage surgical event. Perihepatic packing (PP) and temporary abdominal closure (TAC) with delayed biliary reconstruction (DBR) can be applied in these circumstances. Method A prospective database of LT in a major transplant center was analyzed to identify patients with massive uncontrollable bleeding during LT that was resolved by PP, TAC, and DBR. Results From January 2009 to July 2013, 20 (3.6%) of 547 patients who underwent LT underwent DBR. Mean intraoperative blood loss was 20,500 ml at the first operation. The DBR was performed with a mean of 55.2 h (16–110) after LT. Biliary reconstruction included duct-to-duct (n = 9) and hepatico-jejunostomy (n = 11). Complications occurred in eight patients and included portal vein thrombosis, cholangitis, severe bacteremia, pneumonia. There was one in-hospital death. In the follow-up of 18 to 33 months we have seen one patient died 9 months after transplantation. The remaining 18 patients are alive and well. Conclusions In case of massive uncontrollable bleeding and bowel edema during LT, the combined procedures of PP, TAC, and DBR offer an alternatively surgical option to solve the tough situation. |
| Databáze: | OpenAIRE |
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