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    Management of hemorrhage of retro hepatic inferior vena cava injury during piggy-back technique for liver transplantation
    (Springer India, 2008) Unal, Aydin; Pinar, Yazici; Murat, Zeytunlu; Murat, Kilic
    Background Injury to large abdominal vessels is still one of the most terrifying results of trauma or intraoperative faults, as the management of the hemorrhage is hardly difficult due to being torrentially and unaware of the proper reparation. The controversial problem is which technique should be preferred in case of injury to RHIVC and how can it be managed with minimal risk. Patients and Methods Over two-year period, we retrospectively analyzed the patients who had undergone adult-to-adult liver transplantation and collected data about the injuries to RHIVC during recipient hepatectomy. All patients were treated with the same surgical technique including digital compression and continuous suturing the tear. Results Twenty five patients (21 male, 4 female) were detected. The causative factors for end stage liver disease included hepatitis B, hepatitis C with or without hepatocellular carcinoma, autoimmune hepatitis, alcoholic hepatitis, cryptogenic hepatitis, Wilson disease, and nonalcoholic steatohepatitis. Mean diameter of the injury was measured 0.5 cm (range: 0.2-1.6). Only three patients (12%) had more than one injury. Mean amount of blood loss between injury and repair was 130 cc (40-350 cc). There was no operative mortality. Conclusion Calmness of the operative team followed by the appropriate surgical approach is the key of the success in case of any injury to RHIVC. Digital compression technique can be enough to prevent massive bleeding and repair the injury tract without any vascular exclusion that may result with serious postoperative complications. We proposed this technique because of its ability by most surgeon and easy to perform in a safe way.
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    A new approach to the surgical treatment of parasitic cysts of the liver: Hepatectomy using the liver hanging maneuver
    (W J G Press, 2007) Unal, Aydin; Pinar, Yazici; Murat, Zeytunlu; Murat, Kilic; Ahmet, Coker
    AIM: To review 11 patients with parasitic cysts of the liver, who were treated by hepatic lobectomy using the liver hanging maneuver (LHM). METHODS: Between January 2003 and June 2006, we retrospectively analyzed patients who underwent surgical treatment due to parasitic cysts of the liver, at the Ege University School of Medicine, Department of General Surgery. Of these, the patients who underwent hepatic lobectomy using the LHM were reviewed and evaluated for surgical treatment outcome. RESULTS: Over a three-year period, there were 102 patients who underwent surgical treatment for parasitic cysts of the liver. Of these, 11 (10%) patients with parasitic cysts of the liver underwent hepatic lobectomy using the LHM. Presenting symptoms were abdominal pain, dyspepsia, and cholangitis. Cyst locations were as follows: right lobe filled with cyst, 7 (63%); segmental location, 2 (18%); and multiple locations, 2 patients (18%). All patients underwent hepatic lobectomy with an anterior approach using the LHM. The intraoperative blood transfusion requirement was one unit for 3 patients and two units for one patient. Postoperative complications included pulmonary atelectasy (2, 18%) and pleural effusion (2, 18%). No significant morbidity or mortality was observed. CONCLUSION: We concluded that hepatic lobectomy using the LHM should be considered, not only for hepatic tumors or donor hepatectomy, but also to treat parasitic cysts of the liver. (c) 2007 The WJG. All rights reserved.