PURPOSE: Groove pancreatitis is a rare specific form of chronic pancreatitis that extends into the anatomical area between the pancreatic head, the duodenum, and the common bile duct, which are referred to as the groove areas. We present the diagnostic modalities, pathological features and clinical outcomes of a series of symptomatic patients with groove pancreatitis who underwent pancreaticoduodenectomy. METHODS: Six patients undergoing pancreaticoduodenectomy between May 2006 and May 2009 due to a clinical diagnosis of symptomatic groove pancreatitis were retrospectively included in the study. RESULTS: Five cases were male and one case was female, with a median age at diagnosis of 50 years. Their chief complaints were abdominal pain and vomiting. Abdominal computed tomography, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography were performed. Preoperative diagnosis of all patients was groove pancreatitis. Histological finding was compatible with clinically diagnosed groove pancreatitis in five patients and the pathologic diagnosis of the remaining patient was adenocarcinoma of distal common bile duct. Following pancreaticoduodenectomy, four living patients experienced significant pain alleviation. CONCLUSION: The diagnostic imaging modalities of choice for groove pancreatitis are computed tomography and endoscopic ultrasonography. If symptomatic groove pancreatitis is suspected, careful follow-up of patients is necessary and pancreaticoduodenectomy seems to be a reasonable treatment option.
Abdominal Pain ; Adenocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Chronic Disease ; Common Bile Duct ; Diagnostic Imaging ; Duodenum ; Endosonography ; Female ; Head ; Humans ; Male ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic ; Retrospective Studies ; Vomiting

Necrotizing fasciitis is a rapidly spreading subcutaneous infection. It can occur in patients after solid organ transplantation. But, the reports for necrotizing fasciitis after liver transplantation are very unusual. We report 2 patients with necrotizing fasciitis caused by bacterial and Aspergillus species infection. Their pre-transplantation condition was very poor due to hepatic encephalopathy, pressure sore, and admission for several months. Patients had a fulminant course for early potent immunosuppression period, despite of aggressive surgical debridement, withdrawal of immunosuppression, and adequate antibacterial and antifungal therapy. Therefore, necrotizing fasciitis has to be recognized as a potential complication after liver transplantation and Aspergillus species has to be added to the list of potential pathogens of surgical wound infections, especially in the setting of liver transplantation.
Aspergillus ; Debridement ; Fasciitis ; Fasciitis, Necrotizing ; Hepatic Encephalopathy ; Humans ; Immunosuppression ; Liver ; Liver Transplantation ; Necrosis ; Organ Transplantation ; Pressure Ulcer ; Surgical Wound Infection ; Transplants

Securing the source of hepatic artery inflow is essential for living donor liver transplantation. However, sometimes, the hepatic arteries of the recipients are in poor condition for a good anastomosis in living donor liver transplantation; problems include severe arteriosclerosis, intimal dissection, and significant intimal injuries caused by previous transarterial procedures. In these conditions, the right gastroepiploic artery has generally been the preferred artery because of its anatomical location, size and length. Here, a case of successful hepatic artery reconstruction is reported using the right gastroepiploic artery in living donor liver transplantation. The recipient's hepatic arterial intima was severely injured by multiple transarterial chemoembolization and unsuitable for reconstruction. Instead, the right gastroepiploic artery was anastomosed to the hepatic artery of the graft. Arterial blood flow was satisfactory on Doppler ultrasonography during the operation, and complications related to the hepatic artery were not detected during the follow-up period. Therefore, the right gastroepiploic artery may be considered as a suitable alternative for hepatic artery reconstruction in living donor liver transplantation.
Arteries ; Arteriosclerosis ; Follow-Up Studies ; Gastroepiploic Artery ; Hepatic Artery ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Transplants ; Tunica Intima ; Ultrasonography, Doppler

End-stage liver disease is often accompanied by portal vein thrombosis (PVT) and large spontaneous splenorenal shunts (SRS). Recently, renoportal anastomosis (RP-A) of spontaneous splenorenal shunts in liver transplantation was reported as an effective method of portal vein reconstruction in cases of PVT with SRS. Here we report a successful case of RP-A in living donor liver transplantation (LDLT). A 46-year-old female with a large spontaneous splenorenal shunt and a portal vein thrombosis propagated to the superior mesenteric vein underwent living donor liver transplantation. At the operation, a side-to-end renoportal anastomosis was done using an interposing cadaveric iliac vein graft. Adequate portal venous blood flow was demonstrated by intraoperative and postoperative Doppler ultrasound studies. She has recovered well with normal graft function and renal function. Renoportal anastomosis for patients with large splenorenal shunts and expansive portal vein thrombosis to the superior mesenteric vein can be an effective and safe technique in patients PV thrombectomy.
Cadaver ; Female ; Humans ; Iliac Vein ; Liver ; Liver Diseases ; Liver Transplantation ; Living Donors ; Mesenteric Veins ; Middle Aged ; Portal Vein ; Splenorenal Shunt, Surgical ; Thrombectomy ; Thrombosis ; Transplants

We present a 45-year-old man with chronic pancreatitis and the rare complication of large subcapsular splenic pseudocyst. He suffered from a slow growing left upper quadrant abdominal distension for 2 weeks and pain radiating to his back. On abdominal computed tomography, large subcapsular splenic pseudocyst (25x13x11 cm), multiple small sized pancreatic pseudocysts in the pancreas tail and chronic pancreatitis with multiple pancreatic stones were shown. He underwent percutaneous catheter drainage of the splenic pseudocyst and after 3 weeks, the size of the pseudocyst decreased. But, the pain radiating to his back and poor oral intake was not improved. Distal pancreatectomy, Roux-en-Y pancreaticojejunostomy, and splenectomy were performed and the patient was discharged after 2 weeks. A splenic subcapsular pseudocyst resulting from pancreatitis may be managed by percutaneous drainage, but according to a patient's clinical symptoms, operative management can be added.
Catheters ; Drainage ; Humans ; Middle Aged ; Pancreas ; Pancreatectomy ; Pancreatic Pseudocyst ; Pancreaticojejunostomy ; Pancreatitis ; Pancreatitis, Chronic ; Spleen ; Splenectomy

PURPOSE: The increasing number of recipients on the waiting list for orthotopic liver transplantation (OLT) and the scarcity of donors contribute to recipient's pre-transplantation mortality. So, the expansion of donor criteria has become necessary with the increasing number of liver transplantation candidates, as aged donors who have been considered to yield marginal organs. METHODS: We retrospectively analyzed the 18 deceased donor liver transplantations which had been performed between November 2004 and December 2007. Nine patients received liver grafts from donors older than 50 years, the other 9 patients from donors younger than 40 years. Pre- transplantation characteristics of donors and the early graft outcomes of recipients were evaluated. RESULTS: The pre- transplantation status of the patients who received the older and younger grafts was similar, except donor age. Graft function - as determined by peak aminotransferase levels, prothrombin time (INR) and total bilirubin level after transplantation - was not significantly different in older versus younger grafts. Length of ICU stay and hospital stay of recipients were not influenced from donor's pre-transplant status and cold ischemic time. Fatty changes on frozen section biopsy was related with length of recipient's ICU stay (P=0.049), but all enrolled donors had mild macrovesicular fatty changes (<30%) and fatty changes had no relationship with early graft function and total length of recipient's hospital stay. CONCLUSION: Fifty to sixty-five years brain-dead donors could be transplanted with the same initial success as younger livers provided that other generally accepted donor criteria are satisfactory and the cold ischemic time is short. Further studies should be performed for long-term results and we must make effort to find donors older than 65 years.
Age Factors ; Aged ; Bilirubin ; Biopsy ; Cold Ischemia ; Frozen Sections ; Humans ; Length of Stay ; Liver ; Liver Transplantation ; Prothrombin Time ; Retrospective Studies ; Tissue Donors ; Transplants ; Waiting Lists

PURPOSE: Previous gastrectomy has been considered to be a relative contraindication for laparoscopic common bile duct exploration (LCBDE) because of concerns regarding severe adhesions in the operative field and technical complexity. This study evaluated the feasibility and safety of LCBDE in patients with previous gastrectomy. METHODS: We retrospectively reviewed the clinical outcomes of 58 patients who underwent LCBDE in our institution between January 2005 and December 2014: group I comprised patients with no previous abdominal surgery (n=43) and group II comprised patients with previous gastrectomy (n=15). Patient demographics and perioperative variables were compared between groups. RESULTS: The perioperative variables did not differ significantly between groups. The operating time, open conversion rate, and morbidity rate were similar in groups I and II, despite the more complicated cases in group II. Moreover, the presence of remnant bile duct stones and biliary strictures, and the postoperative hospital stay, did not differ significantly between groups. The mean time to oral intake did not differ between groups, although this diet resumption time was significantly shorter in groups I and II than in a group undergoing open choledocholithomy (p=0.04). CONCLUSION: Laparoscopic common bile duct exploration is safe and effective in patients with histories of gastrectomy.
Bile Ducts ; Choledocholithiasis* ; Common Bile Duct* ; Constriction, Pathologic ; Demography ; Diet ; Gastrectomy* ; Humans ; Laparoscopy ; Length of Stay ; Retrospective Studies

Extensive thrombosis of the portal and splenomesenteric veins combined with cavernous transformation of the portal vein (CTPV) has been considered to be a contraindication for living donor liver transplantation (LDLT) due to technical difficulties and perioperative risks. In recent years, several surgical innovations including cavoportal hemitransposition, renoportal anastomosis, and portal arterialization have been introduced to overcome diffuse portal vein thrombosis (PVT) and CTPV, but their outcomes were unsatisfactory with significant morbidity and mortality. Herein, we report two successful cases of adult LDLT in diffuse PVT with CTPV managed using the paracholedochal vein as portal inflow to the graft.
Adult ; Humans ; Liver Transplantation* ; Living Donors* ; Mortality ; Portal Vein ; Thrombosis ; Transplants ; Veins* ; Venous Thrombosis

BACKGROUND: In living-donor-liver transplantation, microsurgical reconstruction of the hepatic artery is essential and this is challenging issue because of the small diameter of the vessels in the partial liver graft. We present our experiences for hepatic arterial reconstruction with focusing on the technical aspects. METHODS: Methods: From May 2005 through December 2009, 100 patients received right hemiliver grafts (n=86) or left hemiliver grafts (n=14). Hepatic artery anastomosis was performed using microsurgical techniques. All the anastomoses were successfully accomplished by a single transplantation surgeon who worked under a microscope. Our classical method for arterial reconstruction in living donor liver transplantation (LDLT) consists of the interrupted end-to-end anastomosis between the hepatic artery of the graft and the most accessible hepatic artery of the recipient. RESULTS: We could confirm the patency of the reconstructed artery during the early post-transplantation period. Ninety five patients had the hepatic arteries reconstructed by the conventional twist technique. We used the right gastroepiploic artery in one patient because of the intimal dissection of the hepatic artery, and we used an interposition graft, with using the greater saphenous vein, in 2 patients. technical complication was occurred in only 1 patient. The hepatic artery pseudoaneurysm was confirmed at 4 weeks after transplantation. Arterial steal syndrome was detected in 2 patients and this was treated by angiographic techniques. CONCLUSIONS: Meticulous intraoperative microsurgical techniques and careful postoperative evaluation are very important in the hepatic artery reconstruction of LDLT. An experienced transplantation microscopy surgeon is also needed for creating safe anastomosis and achieving a lower complication rate.
Aneurysm, False ; Arteries ; Gastroepiploic Artery ; Hepatic Artery ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Microscopy ; Microsurgery ; Reconstructive Surgical Procedures ; Saphenous Vein ; Thrombosis ; Transplants

PURPOSE: Portal vein thrombosis (PVT) has been considered a relative contraindication for living donor liver transplantation (LDLT). However, it is no longer a contraindication of LDLT due to improvement in surgical techniques and approaches to PVT. The aim of this study was to assess the impact of PVT on outcomes in LDLT patients. METHODS: We retrospectively analyzed the data from 97 adult patients undergoing LDLT in our center from July 2008 to June 2010. Intraoperative findings and preoperative imaging results were reviewed for PVT grading (Yerdel grading). We analyzed the technical aspects and comparisons of risk factors, perioperative variables, and survivals between patients with and without PVT based on the grades. RESULTS: In the 97 LDLT patients, 18 patients were confirmed to have PVT (18.5%) including grade I cases (n = 8), grade II (n = 7), and grade III (n = 3). Prior treatment of portal hypertension was found to be an independent risk factor for PVT (P = 0.001). The comparisons between PVT and no PVT groups showed no significant difference in intraoperative and postoperative variables except for postoperative bleeding (P = 0.036). The short-term portal vein patency, in-hospital mortality and survival rates were not significantly different between the PVT and control groups. CONCLUSION: The outcomes are similar to non-PVT group in terms of in-hospital mortality, survival rates, and postoperative complications. Therefore, our study suggests that PVT cannot be considered to be a contraindication for LDLT and LDLT could be undertaken without increased morbidity and mortality in patients with PVT, in spite of operative complexity.
Adult ; Hemorrhage ; Hospital Mortality ; Humans ; Hypertension, Portal ; Liver ; Liver Transplantation ; Living Donors ; Portal Vein ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Survival Rate ; Thrombosis