Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant

Background Intra-operative bile leakage testing is very important in partial liver resection in living donor liver transplant as it allows detection of bile leaking points on the cut surface and decreases postoperative bile leak which is one of the most dreadful complication following liver transplant surgery. In this study we tried to assess the Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant. Objective In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of biliary leakage in patients who will undergo partial liver resection as living donor liver transplant. Methodology In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of bile leakage in patients who underwent partial liver resection as a living donor liver transplant. This study included 60 patients who received partial liver resection as a living donor liver transplant. The conventional saline test (injecting an isotonic sodium chloride solution through the cystic duct) was carried out in 30 patients and the White test (injecting a fat emulsion solution through the cystic duct) was carried out in 30 patients Results Incidence of postoperative bile leakage was compared between the conventional method and the White test. Bile leakage occurred in 8 patients (26.7%) in the conventional method group and in 2 patients (6.7%) in the White test group. In addition, the White test detected intraoperative a significantly higher number of bile leakage sites compared with the conventional method. The White test is better than the conventional test for the intraoperative detection of bile leakage. Conclusion Based on our study, we recommend that surgeons investigating bile leakage sites during liver resections should use the White test instead of the conventional saline test.

Laparoscopic partial liver resection for hepatocellular carcinoma arising from Fontan-associated liver disease: a case report

Background The Fontan procedure (FP) is a palliative surgery for functional single ventricle. The Fontan circulation maintains pulmonary circulation by a high central venous pressure, leading to chronic congestive liver. The number of patients diagnosed with hepatocellular carcinoma (HCC) arising from liver fibrosis and cirrhosis after FP is increasing. Several reports have described surgical treatment for HCC after FP, but few have described laparoscopic surgery. Case presentation The patient was a 31-year-old man who had undergone the FP for single right ventricle at 3 years. Several liver masses were detected at 30 years. A liver mass in segment 3 showed increasing size concomitant with increasing alpha-fetoprotein concentration, and a solitary HCC 15 mm in diameter was diagnosed. The tumor was located on the liver surface, abutting the origin of the left hepatic vein. Laparoscopic partial liver resection was performed. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The patient remained disease-free on follow-up after 7 months. Conclusions Although we had some concerns, such as difficulty managing general anesthesia and easy venous bleeding due to high central venous pressure, laparoscopic partial liver resection was performed with safe exposure of the left hepatic vein.

Neoangiogenesis in the Econiche of Opisthorchis Felineus After Partial Hepatectomy Accompanied by Superinvasive Opisthorchiasis

Research goal: revealing the liver vessels formation mechanisms after partial hepatectomy accompanied by superinvasive opisthorchiasis (SO).Material and methods. The study was carried out on Syrian hamsters, weighing 98.0–110.0 g, mature animals of both genders. The animals were divided into three groups. Group I (n=168): a model of SO. Group II (n=40): partial liver resection in healthy animals. Group III (n=86): partial hepatectomy accompanied by SO. The histological specimens were stained with Mayer's hematoxylin and eosin by the methods of Van Gieson, Slinchenko, V.V. Kupriyanov. Immunohistochemical reactions were performed using primary antibodies to CD31, CD34, CD117, Oct4, and α-fetoprotein. The results were statistically processed, the differences were considered significant at p<0.05.Results. In animals of group I accompanied by SO, proliferation of progenitor cells (CD31+, CD34+, CD117+, Oct4+) was observed in the portal tracts and perivascular space with the development of vascular formations, cholangiocellular and hepatocellular differnеntiations. Liver regeneration in healthy hamsters during 1– 3 days consisted in an active reaction of mitotic and amitotic division of hepatocytes with the development of avascular islets. In the subsequent periods (the 7th day), the cells of preexisting vascular structures (sinusoids, capillaries) multiplied. After partial hepatectomy accompanied by SO (group III), there was an intensive proliferation of stem and progenitor cells with differentiation into endothelial cells, elements of cholangio- and hepatocellular differnеntiations; endotheliocytes and capillary pericytes multiplied.Conclusion. Neoangiogenesis during regeneration after partial hepatectomy in healthy animals is implemented like angiogenesis; in case of partial liver resection accompanied by SO, it is followed by the vessels formation mainly from progenitor cells (vasculogenesis), advancing the development of elements of cholangio- and hepatocellular differnеntiations.

Enhanced inflammatory response mediated by parenchymal cells associates with resistance towards mTOR inhibition

Activation of the mTOR pathway is frequently found in cancer, but mTOR inhibitors have thus far failed to demonstrate significant antiproliferative efficacy in the majority of cancer types. Besides cancer cell-intrinsic resistance mechanisms, it is conceivable that mTOR inhibitors impact on non-malignant host cells in a manner that ultimately supports resistance of cancer cells. Against this background, we sought to analyze the functional consequences of mTOR inhibition in hepatocytes for the growth of metastatic colon cancer. To this end, we established a liver epithelial cell (LEC)-specific knock-out (KO) of mTOR (mTORLEC mice). We used these mice to characterize the growth of colorectal liver metastases with and without partial hepatectomy to model different clinical settings. While the LEC-specific loss of mTOR remained without effect on metastasis growth in intact liver, partial liver resection resulted in the formation of larger metastases in mTORLEC mice compared to wildtype controls. This was accompanied by significantly enhanced inflammatory activity in LEC-specific mTOR KO livers after partial liver resection. Analysis of NF-κB target gene expression and immunohistochemistry of p65 displayed a significant activation of NF-κB in mTORLEC mice, suggesting a functional importance of this pathway for the observed inflammatory phenotype. Taken together, we show an unexpected acceleration of liver metastases upon deletion of mTOR in liver epithelial cells. Our results support the notion that non-malignant host cells can contribute to resistance against mTOR inhibitors and encourage to test if anti-inflammatory drugs are able to improve the efficacy of mTOR inhibitor for cancer therapy.

Severity assessment in pigs after partial liver resection: evaluation of a score sheet

Severity assessment in biomedical research is required by the European authorities. Therefore, a variety of score sheets are available. The first score sheets were designed and introduced by Morton and Griffith (M&G) in 1985, to assess pain and distress in animals. Score sheets are an important part of the 3R principles to evaluate the degree of severity in different studies. Here, we used a modified score sheet from M&G for severity assessment of 12 Aachen minipigs after partial liver resection for safety testing of a novel synthetic sealant (VIVO-107). The control group was treated with the clinical standard fibrin. Estimation of recovery status of both groups was performed from the day of surgery to postoperative day 7 using a score sheet. Included parameters were blood loss during the surgical procedure, general state, spontaneous behaviour and clinical results. Values from 0 to 20 were graded for each category and resulted in the degree of strain (DS) from DS0 to DS4. An increasing DS indicated higher severity. Suitability of the implemented score sheet was evaluated. Higher score points were documented almost exclusively as an outcome of the clinical results, influenced mainly by increased temperature in the fibrin treated control group, whereas, spontaneous behaviour had only slight influence and general state had no influence. The average score seven days after surgery was <2. The laparotomy, where the partial liver resection is a part, is rated as moderate severity in the EU Directive 2010/63, while the assessment done in the present study hints to a mild severity of the model in our hands.