Heart Defects, Congenital ; complications ; surgery ; Humans ; Hypertension, Pulmonary ; etiology ; surgery

Biliary Tract Diseases ; complications ; surgery ; Humans ; Hypertension, Portal ; complications ; etiology ; surgery ; Liver Cirrhosis ; complications ; surgery ; Perioperative Care

Hemodynamics ; Humans ; Hypertension, Portal ; etiology ; physiopathology ; surgery ; Liver Cirrhosis ; complications ; physiopathology ; surgery ; Liver Transplantation ; Postoperative Period

Humans ; Hypertension, Portal ; etiology ; surgery ; Liver Cirrhosis ; complications ; surgery ; Liver Transplantation ; Portasystemic Shunt, Surgical ; methods

Hypersplenism, secondary to portal hypertension, is common in hepatocellular carcinoma (HCC) with liver cirrhosis. Hepatic resection in the patient with hypersplenic thrombocytopenia (HSTC) may cause a perioperative bleeding episode and sometimes, liver failure. In order to investigate the effect of concomitant splenectomy in HCC patients with HSTC, clinical parameters are retrospectively reviewed for 18 HCC patients who underwent hepatic resection with or without splenectomy. Among 581 HCC patients who underwent hepatic resection during the past 17 years, 18 patients with HSTC were investigated. Twelve of them underwent hepatic resection for HCC and had a concomitant splenectomy and the remaining 6 patients underwent hepatic resection for HCC only. The clinical outcomes and postoperative changes in platelet count, serum albumin level, serum total bilirubin levels, prothrombin time and clinical staging (Child-Pugh Classification) were reviewed. The resected spleen mean weight was 350.7+/-102.9 g. Postoperative platelet counts were significantly increased with albumin levels and clinical staging scores also improved after the splenectomy. Among the 12 patients who had a splenectomy, 6 patients had postoperative complications and one died of recurrent variceal bleeding. According to this data, it is not harmful to perform a concomitant splenectomy and hepatectomy for the HCC patient with severe HSTC, it can even be beneficial in improving both the platelet count and clinical staging.
Adult ; Carcinoma, Hepatocellular/*complications/surgery ; Female ; Hepatectomy ; Human ; Hypersplenism/*etiology/*surgery ; Hypertension, Portal/*complications ; Liver Neoplasms/*complications/surgery ; Male ; Middle Aged ; *Splenectomy

<0.01). The cumulative 3-year recurrence-free survival rate showed no statistical difference between the two groups. However, the cumulative 3-year survival rate was significantly higher in the non-portal hypertension group (82.8% vs. 53%, respectively, P=0.014). CONCLUSION: Indirectly diagnosed portal hypertension is correlated with the development of complications and poor prognosis after the surgical resection of HCC.
Adult ; Aged ; Carcinoma, Hepatocellular/complications/*surgery ; Female ; Humans ; Hypertension, Portal/*diagnosis/etiology ; Liver Neoplasms/complications/*surgery ; Male ; Middle Aged ; Postoperative Complications/*diagnosis ; Prognosis ; Survival Rate

OBJECTIVETo evaluate the clinical efficacy and safety of hand-assisted laparoscopic surgery (HALS) vs. open surgery (OS) for portal hypertension.

METHODSRelevant literature was retrieved from databases including PubMed, EMBASE, Cochrane Library, Chinese Biomedical Literature Database, Chinese Journal Full Text Database, Chinese Vip Datebase, and Chinese Wanfang. All the relevant trials were collected and then we performed the literature screening. The quality of the included trials was assessed by Cochrane Systematic Review Handbook 5.1. Meta-analyses were conducted by RevMan 5.1 software.

RESULTSEight studies were involved and 435 patients were included. Meta-analysis showed that there was significant difference in intraoperative blood loss [MD = -140.95, 95% CI = (-233.58--48.32), P=0.003], total abdominal drainage volume [MD = -544.32, 95% CI= (-789.97--298.67), P<0.0001], postoperative exhaust time [MD = -28.30, 95% CI= (-41.90--14.69), P<0.0001], length of postoperative hospital stay [MD =-3.61, 95% CI= (-4.16--3.07), P<0.00001], postoperative complication [OR=0.35, 95% CI= (0.15-0.82), P=0.02] between HALS group and OS group. However, the operative time was not significantly different between these two groups [MD = -7.44, 95% CI = (-36.00 -21.12), P=0.61].

CONCLUSIONSCompared with the traditional OS, HALS can reduce intraoperative bleeding, postoperative exhaust time, hospitalization time, surgical trauma, and postoperative complications.The patients often recover more quickly from the HALS. However, its long-term effictiveness and safety still needs to be further verified by randomized controlled trials.

Esophageal and Gastric Varices ; etiology ; surgery ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; Humans ; Hypertension, Portal ; complications

Humans ; Hypertension, Portal ; physiopathology ; surgery ; Liver ; physiopathology ; Liver Cirrhosis ; complications ; Liver Transplantation ; Portasystemic Shunt, Transjugular Intrahepatic

Primary aldosteronism (PA) is a frequent cause of secondary hypertension and is amenable to surgical intervention when it is caused by aldosterone-producing adenoma (APA). Many patients, however, continue to require antihypertensive medications to control their blood pressure after adrenalectomy. The aim of this study was to determine the preoperative factors that predict clinical outcomes after adrenalectomy in patients with APA. We studied 27 patients (mean age 45+/-4 yr) who had APA and underwent unilateral adrenalectomy between December 1995 and September 2008 at our institution. Clinical and biochemical data were evaluated at baseline and after a mean follow-up of 51.8+/-47.0 months (range, 6-159). At the end of the follow-up, 16 patients (59.3%) were considered to experience "complete resolution" without postoperative medications, whereas 7 patients (25.9%) "improved" with medications and 4 patients (14.8%) were "uncontrolled." Three factors (< or =2 antihypertensive medications [P=0.007], duration of hypertension <6 yr [P=0.002], and serum aldosterone <350 pg/mL [P<0.001]) were the predictive for complete resolution in univariate analysis. Multivariate regression analysis showed that serum aldosterone level (<350 pg/mL) was the single most important factor that predicted complete resolution after surgery (P<0.001). The best preoperative clinical factor that predicted resolution of postoperative hypertension after adrenalectomy is serum aldosterone level (<350 pg/mL).
*Adrenalectomy ; *Adrenocortical Adenoma/complications/surgery ; Adult ; Aldosterone/*blood ; Female ; Humans ; *Hyperaldosteronism/complications/surgery ; *Hypertension/etiology/surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome