Displaying all 17 publications

  1. Ariffin AC
    World J Surg, 2018 05;42(5):1563-1564.
    PMID: 28932972 DOI: 10.1007/s00268-017-4252-8
    Matched MeSH terms: Hepatectomy*
  2. Yugasaravanan K, Affirul CA, Zamri Z, Azlanudin A, Bong JJ
    Clin Ter, 2015;166(2):e102-4.
    PMID: 25945439 DOI: 10.7417/CT.2015.1828
    BACKGROUND: Post-hepatectomy bile leak may lead to undesired morbidity. Multiple methods have been employed to identify this leak but can be inconclusive and taxing. This novel white gauze test is a simple and reliable method.

    MATERIALS AND METHODS: This is a prospective study performed from January 2010 until March 2011. All open hepatic resection were included. Dry white gauze is compressed onto the transected surface and observed for bile staining. The leaking duct is repaired immediately upon detection. The process is repeated until negative. Drain was removed on postoperative day-5. Post-operative bile leak is defined as: 1. Bilirubin concentration of the drain fluid is 3 times or higher than serum; 2. Presence of intra-abdominal bile collection on imaging and upon drainage; 3. Bile leak demonstrated on postoperative cholangiography.

    RESULTS: 42 patients were recruited. Seven (16.7%) patients were cirrhotic with Child-Pugh A. White gauze test were positive for intra-operative bile leaks in 29 patients (70%), which were primarily repaired. As a result, there was no postoperative bile leak in this series. One mortality was detected in this series due to postoperative pancreatic fistula and multi organ failure.

    CONCLUSIONS: The White Gauze Test is a useful method for the prevention of bile leakage after hepatic resection. It is safe, quick and cheap.

    Matched MeSH terms: Hepatectomy*
  3. Alirr OI, Abd Rahni AA
    Int J Comput Assist Radiol Surg, 2020 Feb;15(2):239-248.
    PMID: 31617057 DOI: 10.1007/s11548-019-02078-x
    PURPOSE: For the liver to remain viable, the resection during hepatectomy procedure should proceed along the major vessels; hence, the resection planes of the anatomic segments are defined, which mark the peripheries of the self-contained segments inside the liver. Liver anatomic segments identification represents an essential step in the preoperative planning for liver surgical resection treatment.

    METHOD: The method based on constructing atlases for the portal and the hepatic veins bifurcations, the atlas is used to localize the corresponding vein in each segmented vasculature using atlas matching. Point-based registration is used to deform the mesh of atlas to the vein branch. Three-dimensional distance map of the hepatic veins is constructed; the fast marching scheme is applied to extract the centerlines. The centerlines of the labeled major veins are extracted by defining the starting and the ending points of each labeled vein. Centerline is extracted by finding the shortest path between the two points. The extracted centerline is used to define the trajectories to plot the required planes between the anatomical segments.

    RESULTS: The proposed approach is validated on the IRCAD database. Using visual inspection, the method succeeded to extract the major veins centerlines. Based on that, the anatomic segments are defined according to Couinaud segmental anatomy.

    CONCLUSION: Automatic liver segmental anatomy identification assists the surgeons for liver analysis in a robust and reproducible way. The anatomic segments with other liver structures construct a 3D visualization tool that is used by the surgeons to study clearly the liver anatomy and the extension of the cancer inside the liver.

    Matched MeSH terms: Hepatectomy/methods*
  4. Rahman Jamal, Sharifah, N.A., Zulfiqar, A., Zakaria, Z.
    We report a rare case of undifferentiated (embryonal) sarcoma of the liver in a six-year-old girl who at presentation, had fever, right hypochondrium pain and hepatomegaly. The diagnosis was clinched by fine needle aspiration cytology and was subsequently reconfirmed by histopathological examination of the resected tumour. Pre-operative chemotherapy was given because primary resection was deemed not possible. The patient underwent a successful extensive hepatectomy followed by continuation chemotherapy
    Matched MeSH terms: Hepatectomy
  5. Ikhwan SM, Zamri Z, Hairol O, Razman J, Affirul C
    Extrahepatic bile ducts constitute a significant anatomic site for surgeons when performing hepatobiliary
    operations from minor procedure such as cholecystectomy to major operation such as hepatectomy. The
    challenges for surgeon in performing such cases increase when congenital variance of biliary tree occurs which
    may lead to unintentional bile duct injuries. We reported a case of a lady who presented with obstructive
    jaundice secondary to huge distal common bile duct stone. The presence of right posterior segmental hepatic
    duct, which rarely occurs, was discovered during intraoperative cholangiogram before common bile duct
    exploration. The operation was successful without incidence of biliary duct injury.
    Matched MeSH terms: Hepatectomy
  6. Haron A, Hisham AN, Samad SA
    Med J Malaysia, 1994 Mar;49(1):86-9.
    PMID: 8057997
    A case of symptomatic polycystic liver disease treated by fenestration and segmental liver resection is reported. The intraoperative use of ultrasound to define the plane of liver resection is emphasised. No significant post-operative complication was encountered. The clinical presentation, management and treatment are discussed.
    Matched MeSH terms: Hepatectomy/methods*
  7. Lin KH, Hsu HT, Teng TH, Lin PY, Ko CJ, Hsieh CE, et al.
    Malays J Pathol, 2017 Dec;39(3):289-291.
    PMID: 29279592
    BACKGROUND: Liver regeneration is dependent on the proliferation of hepatocytes. Hepatic progenitor cells are intra-hepatic precursor cells capable of differentiating into hepatocytes or biliary cells. Although liver progenitor cell proliferation during the regenerative process has been observed in animal models of severe liver injury, it has never been observed in vivo in humans because it is unethical to take multiple biopsy specimens for the purpose of studying the proliferation of liver progenitor cells and the roles they play in liver regeneration. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a staged procedure for inducing remnant liver hypertrophy so that major hepatectomy can be performed safely. This staged procedure allows for liver biopsy specimens to be taken before and after the liver begins to regenerate.

    CASE PRESENTATION: The liver progenitor cell proliferation is observed in a patient undergoing ALPPS for a metastatic hepatic tumour. Liver biopsy is acquired before and after ALPPS for the calculation of average number of liver progenitor cell under high magnification examination by stain of immunomarkers. This is the first in vivo evidence of growing liver progenitor cells demonstrated in a regenerating human liver.

    Matched MeSH terms: Hepatectomy/methods
  8. Yang S, Tan TM, Wee A, Leow CK
    Cell Mol Life Sci, 2004 Jan;61(2):220-9.
    PMID: 14745500
    For many liver malignancies, major hepatectomy is the usual therapy. Although a normal liver has a tremendous capacity for regeneration, liver hepatectomy in humans is usually carried out on a diseased liver and, in such cases, liver regeneration takes place in a cirrhotic remnant. Mitochondrial function in cirrhotic livers shows a variety of changes compared to control livers. This study investigated how mitochondrial respiratory function and antioxidant capacity change following partial hepatectomy of cirrhotic livers, because liver regeneration requires greater energy demands and control of oxidative stress. Cirrhosis was induced in male Wistar-Furth rats by administration of thioacetamide. NADH-cytochrome c reductase activity, mitochondrial glutathione peroxidase activity and mitochondrial GSH levels were all significantly lowered in cirrhotic livers and in the cirrhotic remnants up to 72 h after 70% hepatectomy when compared to the corresponding controls. Lower respiratory control ratios with succinate as substrate were also observed from 6 to 48 h post-hepatectomy. At 24 h post-hepatectomy, higher levels of lipid peroxidation were observed. We conclude that, compared to the controls, cirrhotic livers have diminished oxidative phosphorylation capabilities due to changes in NADH and FADH(2)-linked respiration as well as impaired antioxidant defenses following partial hepatectomy. Both of these factors, if critical, could then impede liver regeneration.
    Matched MeSH terms: Hepatectomy*
  9. Jarmin, R., Othman, H., Zuhdi, Z., Mohamad, I.S., Ahmad, A.W., Ariffin, A.C.
    Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other
    surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same
    time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for
    liver resection was initiated.

    Objective: The aim of this study was to achieve discharge by postoperative
    day 3 for minor resection and day 5 for major resection.

    Design and Setting: This is a prospective study
    conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015.

    and Methods: All patients undergoing open liver resection were included in the study. They were then
    managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s
    demographics data, intra operative parameters, postoperative complications and adherence to
    postoperative recovery protocol were recorded.

    Results: Seventeen patients (7 major and 10 minor
    resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection
    was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%)
    in the major group were discharged on time. 9 patients had postoperative complications with no mortality
    recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in
    15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients -
    35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14

    Conclusion: From these overall achievement, most of our targets have been met and this shows
    that our ERAS protocol is safe to be applied to patient undergoing hepatectomy.

    Limitations: Some patients
    had achieved their target but not discharged for unknown reason.
    Matched MeSH terms: Hepatectomy
  10. Cheung TT, Han HS, She WH, Chen KH, Chow PKH, Yoong BK, et al.
    Liver Cancer, 2018 Mar;7(1):28-39.
    PMID: 29662831 DOI: 10.1159/000481834
    Background: Laparoscopic liver resection has been gaining momentum, and it has become an accepted practice after the two international consensus conferences where experts worked up guidelines to standardize this approach and improve its safety. However, most laparoscopic hepatectomies were performed in patients with liver metastases. The concurrent presence of liver cirrhosis with hepatocellular carcinoma (HCC) poses a great challenge to clinicians trying to establish a routine use of laparoscopic liver resection for HCC.

    Summary: The first Asia Pacific consensus meeting on laparoscopic liver resection for HCC was held in July 2016 in Hong Kong. A group of expert liver surgeons with experience in both open and laparoscopic hepatectomy for HCC convened to formulate recommendations on the role and perspective of laparoscopic liver resection for primary liver cancer. The recommendations consolidate the most recent evidence pertaining to laparoscopic hepatectomy together with the latest thinking of practicing clinicians involved in laparoscopic hepatectomy, and give detailed guidance on how to deploy the treatment effectively for patients in need.

    Key Message: The panel of experts gathered evidence and produced recommendations providing guidance on the safe practice of laparoscopic hepatectomy for patients with HCC and cirrhosis. The inherent advantage of the laparoscopic approach may result in less blood loss if the procedure is performed in experienced centers. The laparoscopic approach to minor hepatectomy, particularly left lateral sectionectomy, is a preferred practice for HCC at experienced centers. Laparoscopic major liver resection for HCC remains a technically challenging operation, and it should be carried out in centers of excellence. There is emerging evidence that laparoscopic liver resection produces a better oncological outcome for HCC when compared with radiofrequency ablation, particularly when the lesions are peripherally located. Augmented features in laparoscopic liver resection, including indocyanine green fluorescence, 3D laparoscopy, and robot, will become important tools of surgical treatment in the near future. A combination of all of these features will enhance the experience of the surgeons, which may translate into better surgical outcomes. This is the first consensus workforce on laparoscopic liver resection for HCC, which is a unique condition that occurs in the Asia Pacific region.

    Matched MeSH terms: Hepatectomy
  11. Ramanujam TM, Ramesh JC, Goh DW, Wong KT, Ariffin WA, Kumar G, et al.
    J Pediatr Surg, 1999 Nov;34(11):1684-6.
    PMID: 10591570
    Here the first case in the literature of both mesenchymal hamartoma and malignant mesenchymoma occurring in a 6-year-old male child, at different times and at different sites in the liver, and also the possible malignant transformation of a mesenchymal hamartoma is reported. The tumor developed from a lesion in the right lobe that was overlooked initially during a left lateral segmentectomy at 18 months of age for a mesenchymal hamartoma. Malignant mesenchymoma is a rare and aggressive tumor. The origin of this tumor is not well understood. There has been no direct support to the hypothesis that malignant mesenchymoma may be the malignant counterpart of mesenchymal hamartoma. The authors provide clinical and histopathologic evidence in our case that suggests the possibility of malignant mesenchymoma arising from a mesenchymal hamartoma. This case emphasizes the need for complete removal of mesenchymal hamartoma and the need for long-term follow-up to detect multifocal lesion or malignant transformation.
    Matched MeSH terms: Hepatectomy/methods
  12. Koh PS, Koong JK, Westerhout CJ, Yoong BK
    J Gastroenterol Hepatol, 2013 Jul;28(7):1075.
    PMID: 23782121 DOI: 10.1111/jgh.12254
    Matched MeSH terms: Hepatectomy
  13. Sundram F
    Biomed Imaging Interv J, 2006 Jul;2(3):e40.
    PMID: 21614248 MyJurnal DOI: 10.2349/biij.2.3.e40
    Hepatocellular carcinoma (HCC) is a malignant tumour of the hepatocyte. It is a common malignancy worldwide and causes almost half a million deaths annually. Asia is a high risk area. Although surgery (hepatectomy or liver transplantation) is the main form of curative treatment, the majority of patients are not eligible for surgery due to extent of tumour and dysfunction of liver. Radiopharmaceuticals used for transarterial treatment of HCC were Yttrium-90 microspheres, Iodine-131 lipiodol, Rhenium-188 lipiodol, and Holmium-166 Chitosan complex. Yittrium-90 microspheres are glass or resin microspheres of mean sphere diameter of 20 to 30 micrometre. The activity administered was about 4 GBq. Reported response rate was about 20%, and median survival was 54 weeks. On inoperable tumours, reported objective response of I-131 lipiodol was 40 to 70%, and median survival was six to nine months. It showed efficacy similar to TACE. In adjuvant treatment following curative resection of HCC, reported three year survival was 86% compared with 46% for the control group. The administered activity in both adjuvant and inoperable HCC was about 2 GBq (55 mCi). Rhenium-188 lipiodol is a new radioconjugate, and using it we treated 70 patients with inoperable HCC. This treatment was a part of a multi-centre trial sponsored by the International Atomic Energy Agency. Partial response was obtained in 17% of cases, while 49% had stable disease at three months, and 34% showed disease progression. In terms of survival, 19% survived one year, 60% for six months, and 90% for three months. The mean activity was about 4.6 GBq (124 mCi). This method was safe and free from adverse effects.
    Matched MeSH terms: Hepatectomy
  14. Balasegaram M
    Ann. Surg., 1972 Feb;175(2):149-54..
    PMID: 5059599
    Matched MeSH terms: Hepatectomy
  15. Kaur G, Mutum SS
    Malays J Med Sci, 2001 Jan;8(1):69-72.
    PMID: 22973160
    Hepatoblastoma is the most common primary liver tumour of childhood. This is a case report of a one-year-old boy who presented with a one-month history of progressive abdominal distension and weight loss. He was cachexic, anaemic, had gross hepatomegaly and ascites. He had been born prematurely with a birth weight of 1.23 kg, and his developmental milestones were delayed. Ultrasound and CT scan demonstrated a large solid tumour in the left lobe of the liver with a smaller superficial nodule in the right lobe. Serum alpha fetoprotein was significantly raised. A left lobe hepatectomy and complete excision of the right sided nodule was performed. There was no evidence of metastatic disease. Histopathological examination confirmed hepatoblastoma of the fetal type. The patient developed features of intestinal obstruction a few days after surgery and he succumbed ten days after re-laparotomy. The clinical presentation and investigation results in this case are characteristic. Recent reports have suggested a strong relationship between very low birth weight (< 1500gm)/prematurity and hepatoblastoma as is present in this case. Surgery is the mainstay of therapy in hepatoblastoma. A brief review of the literature on this tumour is presented.
    Matched MeSH terms: Hepatectomy
  16. Sharifah NA, Muhaizan WM, Rahman J, Zulfikar A, Zahari Z
    Malays J Pathol, 1999 Dec;21(2):105-9.
    PMID: 11068415
    The cytological features of a rare case of undifferentiated (embryonal) sarcoma of the liver are presented. The cytology smears showed singly dispersed polygonal and spindle cells as well as loose clusters of cells held together in myxoid material. Neoplastic cells were generally large with round, oval or lobulated nuclei. The cytoplasm was variable in amount with ill-defined borders. Occasional multinucleated cells were also present. Hyaline globules were present on sections of the cell block. Immunohistochemical studies performed showed positivity for vimentin, cytokeratin and alpha-1-antitrypsin (AAT) in the tumour cells.
    Matched MeSH terms: Hepatectomy
  17. Balasegaram M
    Am. J. Surg., 1975 Jul;130(1):33-7.
    PMID: 50750
    A review of 352 patients with primary liver cell carcinoma treated by the author is presented. The poor rate of resectability (7 per cent) has necessitated various forms of treatment over the years. These are described in detail. Based on this experience, the current form of treatment for nonresectable carcinoma is summarized. Although it is too early to assess this form of treatment, initial results appear to be promising. A second report in the near future is planned.
    Matched MeSH terms: Hepatectomy
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