Study the effect of residual liver function in Cirrhotic patients on meld scoring system and child-pugh's score

Introduction. Laparoscopic liver resection is considered risky in cirrhotic patients, even if minor surgical trauma of laparoscopy could be useful to prevent deterioration of a compromised liver function. This study aimed to identify the differences in terms of perioperative complications and early outcome in cirrhotic patients undergoing minor hepatic resection for hepatocellular carcinoma with open or laparoscopic technique. Methods. In this retrospective study, 156 cirrhotic patients undergoing liver resection for hepatocellular carcinoma were divided into two groups according to type of surgical approach: laparoscopy (LS group: 23 patients) or laparotomy (LT group: 133 patients). Perioperative data, mortality, and length of hospital stay were recorded. Results. Groups were matched for type of resection, median number of nodules, and median diameter of largest lesions. Groups were also homogeneous for preoperative liver and renal function tests. Intraoperative haemoglobin decrease and transfusions of red blood cells and fresh frozen plasma were significantly lower in LS group. MELD score lasted stable after laparoscopic resection, while it increased in laparotomic group. Postoperative liver and renal failure and mortality were all lower in LS group. Conclusions. Lower morbidity and mortality, maintenance of liver function, and shorter hospital stay suggest the safety and benefit of laparoscopic approach.

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Η αξιολόγηση της κάθαρσης του πράσινου της ινδοκυανίνης (ICG) προεγχειρητικά ως μέθοδος ελέγχου της ηπατικής λειτουργίας μετά ηπατεκτομή

10.12681/eadd/38893 ◽

2013 ◽

Author(s):

Μιχαήλ Δέρπαπας

Keyword(s):

Liver Function ◽

Liver Failure ◽

Vena Cava ◽

Normal Liver ◽

Postoperative Liver Failure ◽

Remnant Liver ◽

Total Blood ◽

Hepatic Reserve ◽

Icg Clearance ◽

Residual Liver Function

Purpose: Liver failure is a major cause of early mortality followinghepatectomy. The future-remnant liver function is an important factor whenassessing the risk for postoperative liver impairment. Several techniques havebeen established for this evaluation, including the ICG test. Aim of the study isto evaluate the ICG clearance in patients scheduled for liver resectionregarding perioperative and postoperative risk factors.Methods: Thirty-one patients, scheduled for liver resection, underwent theICG test. Peri-operative and postoperative variables were recorded andanalyzed using non-parametric tests.Results: Procedures extended from wedge excisions to extendedhepatectomies. Major complications included 1 case of a non-ST elevationmyocardial infarct, 1 case of inferior vena cava thrombosis, 2 cases of liverinsufficiency and 1 case of renal failure. Two patients died due to myocardialinfarction and postoperative liver failure respectively. PDR was foundpositively correlated with total blood loss, transfusion and operation duration.Conclusions: The role of residual liver function and particularly the hepaticreserve assessment on liver surgery may be of most benefit in the routinestratification of risk, enabling surgical procedures to be performed with safety.In this study, the ICG clearance markers were found significantly correlated with perioperative risk factors in histologically „normal‟ liver parenchyma.Interpretation of ICG clearance results may appraise in these patients aninadequate hepatic reserve in the remaining parenchyma postoperatively.Thus, in addition to CT volumetry, functional assessment of the hepaticreserve with ICG may persuade the preoperative planning and preventpostoperative liver failure.

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Review: Research Toward Safer Resection of the Cirrhotic Liver

HPB Surgery ◽

10.1155/2000/31945 ◽

2000 ◽

Vol 11 (5) ◽

pp. 285-297 ◽

Cited By ~ 18

Author(s):

M. A. J. Moser ◽

N. M. Kneteman ◽

G. Y. Minuk

Keyword(s):

Surgical Technique ◽

Liver Function ◽

Mortality Rates ◽

Cirrhotic Liver ◽

Morbidity And Mortality ◽

High Morbidity ◽

Hepatic Surgery ◽

Postoperative Course ◽

Cirrhotic Patients ◽

Surgery Resection

Despite recent advances in hepatic surgery, resection of the cirrhotic liver continues to be fraught with high morbidity and mortality rates. As a result, for many patients requiring resection of HCC the postoperative course is complicated and the probability of cure is diminished by coexisting cirrhosis. In this review, we discuss the characteristics of the cirrhotic liver which make it poorly tolerant of resection and the most common complications that follow such surgery. The main purpose of this paper is to review recent attempts to identify interventions that might be beneficial to cirrhotic patients undergoing resection. These interventions include assessment of liver reserve, advances in surgical technique, and improvement in liver function and regeneration.

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The impact of portal vein thrombosis on the prognosis and liver function of nonmalignant cirrhotic patients

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2018.1503327 ◽

2018 ◽

Vol 53 (10-11) ◽

pp. 1340-1346 ◽

Cited By ~ 1

Author(s):

Kei Endo ◽

Takayoshi Oikawa ◽

Keisuke Kakisaka ◽

Akio Tamura ◽

Shigeru Ehara ◽

...

Keyword(s):

Liver Function ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Vein Thrombosis ◽

Cirrhotic Patients ◽

The Impact

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Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients

BioMed Research International ◽

10.1155/2018/3064046 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Du Kong ◽

Wei Wang ◽

Gang Du ◽

Binyao Shi ◽

Zhengchen Jiang ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Function ◽

Blood Loss ◽

Laparoscopic Splenectomy ◽

Postoperative Bleeding ◽

Gastroesophageal Varices ◽

Liver Retraction ◽

Significant Difference ◽

Cirrhotic Patients

Background. Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. Methods. Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. Results. There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. Conclusion. Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.

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Gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)- enhanced magnetic resonance imaging with various enhancement ratios: a correlation with clinical assessment of liver function using the Child-Pugh scoring system

Medical Studies ◽

10.5114/ms.2021.112382 ◽

2021 ◽

Vol 37 (4) ◽

pp. 279-287

Author(s):

Łukasz Wypchło ◽

Jakub Jaskólski ◽

Dorota Zarębska-Michaluk ◽

Ewa Stochmal ◽

Piotr Stępień ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Liver Function ◽

Clinical Assessment ◽

Scoring System ◽

Resonance Imaging

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Assessment of liver function: pre- and peritransplant evaluation

Clinical Chemistry ◽

10.1093/clinchem/43.8.1539 ◽

1997 ◽

Vol 43 (8) ◽

pp. 1539-1545 ◽

Cited By ~ 20

Author(s):

Abraham Shaked ◽

Fredrick A Nunes ◽

Kim M Olthoff ◽

Michael R Lucey

Keyword(s):

Liver Function ◽

Graft Function ◽

Terminal Condition ◽

High Rate ◽

Liver Graft ◽

Therapeutic Modality ◽

Donor Liver ◽

Laboratory Assessment ◽

Residual Liver Function ◽

End Stage

Abstract Liver transplantation has been demonstrated to be a successful therapeutic modality for patients with end-stage liver disease. The high rate of survival for an otherwise terminal condition has resulted in significant expansion of the indications and diseases treated by this procedure, and is hampered only by the limited numbers of organs available for transplantation. Efforts in clinical and laboratory medicine should be directed to identify candidates who would benefit most from this procedure, to provide better means for accurate assessment of liver reserve and the appropriate timing for transplantation, to identify quality liver grafts that would have the potential to tolerate cold preservation and reperfusion injury, and to assist in accurate monitoring of graft function immediately after transplantation. The aim of this manuscript is to describe the existing pathways for clinical and laboratory assessment of pretransplant residual liver function, the donor liver graft, and immediate posttransplantation function.

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