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Lateral Segment (lateral + segment)
Selected AbstractsSpontaneous regression of hepatocellular carcinoma and review of literatureJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2000Yoshio Takeda Abstract A 68-year-old man presented with multiple hepatocellular carcinoma, which was considered to be unresectable at the first admission in January 1994. Pathological diagnosis was made by biopsy of the one lesion among them. From January 1994 to December 1997, 10 transarterial chemoembolizations and six percutaneous ethanol injection therapies were performed on the tumours in the cirrhotic liver. In February 1998 the tumour situated in the right lobe began to increase in size. The maximum tumour diameter was 6.3 cm measured by computed tomography (CT). In the beginning of May 1998 moderate ascites was present and mild hepatic encephalopathy was noticed. The patient was in the terminal stage of hepatocellular carcinoma and no further treatment was possible at that time. However, serum ,-fetoprotein and protein induced by vitamin K absence or antagonist II dramatically decreased in June 1998. The CT scan also showed that the tumour had completely regressed without specific treatment. In February 1999 a new biopsy-proven hepatocellular carcinoma, 2 cm in diameter, developed in the lateral segment of the liver. It was well treated by percutaneous ethanol injection therapy. The patient was alive in good condition without any symptoms or tumour recurrence in June 1999. It was concluded that a rare case of spontaneous regression of hepatocellular carcinoma had occurred. [source] Vascular reconstruction and complications in living donor liver transplantation in infants weighing less than 6 kilograms: The Kyoto experienceLIVER TRANSPLANTATION, Issue 8 2006Yasumasa Shirouzu Smaller-size infants undergoing living-donor liver transplantation (LDLT) are at increased risks of vascular complications because of their smaller vascular structures in addition to vascular pedicles of insufficient length for reconstruction. Out of 585 child patients transplanted between June 1990 and March 2005, 64 (10%) weighing less than 6 kg underwent 65 LDLTs. Median age and weight were 6.9 months (range: 1-16 months) and 5 kg (range: 2.8-5.9 kg), respectively. Forty-five lateral segment, 12 monosegment, and 8 reduced monosegment grafts were adopted, and median graft-to-recipient weight ratio was 4.4% (range: 2.3-9.7). Outflow obstruction occurred in only 1 patient (1.5%). Portal vein complication occurred in 9 (14%) including 5 with portal vein thrombosis. Hepatic artery thrombosis (HAT) occurred in 5 (7.7%). Patient and graft survivals were 73% and 72% at 1 yr, and 69% and 68% at 5 yr after LDLT, respectively. Thirteen of 22 grafts (58%) lost during the follow-up period occurred within the first 3 months posttransplantation. Overall graft survival in patients with and without portal vein complication was 67% and 65%, respectively (P = 0.54). Overall graft survival in patients with and without HAT was 40% and 67%, respectively. HAT significantly affected graft survival (P = 0.04). In conclusion, our surgical technique for smaller-size recipients resulted in an acceptable rate of vascular complications. Overcoming early posttransplantation complications will further improve outcomes in infantile LDLT. Liver Transpl 12:1224,1232, 2006. © 2006 AASLD. [source] Partial left lateral segment transplant from a living donorLIVER TRANSPLANTATION, Issue 1 2000Eduardo de Santibañes A shortage of liver donors for low-weight transplant recipients has prompted the development of procedures for liver-reduction, split-liver, and living related donor transplantations. For pediatric recipients weighing less than 10 kg, the left lateral segment is often still too large. We describe the procedure of monosegmental transplantation using segment II after segment III was resected in situ from a living related donor. Successful monosegmental transplantation is technically feasible and is a valid alternative to be considered for cases of size discrepancy between the recipient's volume and the donor's left lateral segment. [source] Reduced Size Liver Transplantation from a Donor Supported by a Berlin HeartAMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2009M. V. Misra Patients on cardiac assist devices are often considered to be high-risk solid organ donors. We report the first case of a reduced size liver transplant performed using the left lateral segment of a pediatric donor whose cardiac function was supported by a Berlin Heart. The recipient was a 22-day-old boy with neonatal hemochromatosis who developed fulminant liver failure shortly after birth. The transplant was complicated by mild delayed graft function, which required delayed biliary reconstruction and abdominal wall closure, as well as a bile leak. However, the graft function improved quickly over the first week and the patient was discharged home with normal liver function 8 weeks after transplant. The presence of a cardiac assist device should not be considered an absolute contraindication for abdominal organ donation. Normal organ procurement procedures may require alteration due to the unusual technical obstacles that are encountered when the donor has a cardiac assist device. [source] Laparoscopic management of benign liver diseases: where are we?HPB, Issue 4 2004Jean-François Gigot Background The role of laparoscopic surgery in the management of benign cystic and solid liver tumours appears to differ according to each tumour type. As regards congenital liver cysts, laparoscopic treatment is now the gold standard for treating selected, huge, accessible, highly symptomatic or complicated cysts. In contrast, the laparoscopic approach is not useful for patients suffering from adult polycystic liver disease (PLD), except for type I PLD with large multiple hepatic cysts. For benign hepatocellular tumours, the surgical management has recently benefited from a better knowledge of the natural history of each type of tumour and from the improvement of imaging techniques in assuring a precise diagnosis of tumour nature. Thus the general tendency has led to a progressive restriction and tailoring of indications for resection in benign liver tumours, selecting only patients with huge, specifically symptomatic or compressive benign tumours or patients suffering from liver cell adenoma. Despite the enthusiastic use of the laparoscopic approach, selective indications for resection of benign liver tumours should indeed remain unchanged. For all types of benign liver tumours, the best indication remains small, superficial lesions, located in the anterior or the lateral segments of the liver. Deep, centrally located lesions or tumours in contact with major vascular or biliary trunks are not ideal candidates for laparoscopic liver resections. When performed by expert liver and laparoscopic surgeons using an adequate surgical technique, the laparoscopic approach is safe for performing minor liver resections and is accompanied by the usual postoperative benefits of laparoscopic surgery. When applied in selected patients and tumours, laparoscopic management of benign liver diseases appears to be a promising technique for hepatobiliary surgeons. [source] Live donor/split liver grafts for adult recipients: When should we use them?LIVER TRANSPLANTATION, Issue S2 2005Peter Neuhaus Key Points 1Split liver transplantation for a child and an adult recipient is standard today. Living donor liver transplantation for small children should only be necessary in exceptional situations in a country with a well-organized organ donation program. 2True split liver transplantation for two adults is still not very common. In the United States between April 2000 and May 2001, 89 surgical teams transplanted only 15 left lobes and 13 right lobes. Especially left lobes from deceased donors have a poor outcome; in Europe the ELTR shows a 1-year graft survival of 47%. 3While in Asia left lobes, right lateral segments, and dual left lateral segments are more frequently used, living donor liver transplantation for adults in Europe and the United States is predominantly performed with right lobes.7, 8 This carries a significant morbidity and mortality risk for the donor. Outcome compared to deceased donor liver transplantation (DDLTx) is similar with a trend towards more short-term and long-term biliary complications. 4Living donor and split liver transplantation should be used mainly in an elective situation. Candidates are tumor patients, patients with cholestatic liver disease, and elective patients with bile disease. 5Urgent liver transplantation is not a good option for living donor and split liver transplantation. Hepatic assist devices may change the picture in the future. 6Living donor liver transplantation for metabolic disorders like Alpha-1-Antitrypsin deficiency, Hyperoxaluria, and others cannot be recommended at present since the genetically related donor and the patient may carry an unknown risk. (Liver Transpl 2005;11:S6,S9.) [source] | ||||||||||