Abstracts 4. Gemeinsamer Jahreskongress der ... - SWISS KNIFE

swissknife spezial 06 12.06.2006 13:39 Uhr Seite 56
Results: Pure MiS and MaS were present in 3 and 10 patients, respectively, while mixed steatosis
were observed in the remaining 45 patients. Forty four patients (75%) had mild (30%) steatosis. Steatotic patients had significantly higher
changes in AST/ALT, prothrombin time, and bilirubin levels. Blood loss (p=0.04), transfusions
(p=0.03), and ICU stay (p=0.001) were increased in steatotic patients. Overall (50% vs. 25%,
p=0.007) and major complications (27.5% vs. 6.9%, p=0.001) were significantly higher in the
steatotic group compared with the lean group. Patients with pure MaS had increased mortality
(MaS: 20% vs. MiS: 6.6% vs. Mixed: 0%, p=0.36) and major complication rates (MaS: 66%
vs. MiS: 50% vs. Mixed: 24%; p=0.59) but without statistical significance.
Conclusion: Steatosis per se regardless the type is a risk factor for post-operative complications
and should be considered in the planning of extended liver resections.
33.15
H. Petrowsky 1 , M. Selzner 2 , L. McCormack 1 , M. Trujillo 3 , W. Jochum 4 , P. Clavien 5
1 Swiss Hpb Center, Dept. of Visceral and Transplant Surgery, University Hospital of Zurich,
8091 Zurich/CH, 2 Swiss Hpb Center, Dept. of Visceral and Transplant Surgery, University
Hospital of Surgery, 8091 Zurich/CH, 3 Dept. of Visceral and Transplant Surgery, University
Hospital of Zurich, 8091 Zurich/CH, 4 Dept. of Pathology, University Hospital of Zurich, 8091
Zurich/CH, 5 Swiss Hpb Center, Dept. Visceral and Transplant Surgery, University Hospital of
Zurich, 8091 Zurich/CH
Intermittent portal triad clamping vs. ischemic preconditioning for major liver resection: a
randomized controlled trial
Objective: Ischemic preconditioning (IP) with continuous clamping and intermittent clamping
(IC) of the portal triad are distinct protective approaches against ischemic injury which proved
to be superior in randomized controlled trials (RCT) to continuous inflow occlusion alone.
We designed a RCT to evaluate whether IP with continuous clamping or IC of the portal triad
confers better protection during liver surgery.
Methods: Non-cirrhotic patients undergoing major liver resection were randomized to receive
IP with inflow occlusion (n=36) or IC (n=37). Primary end points were postoperative liver injury
and intra-operative blood loss. Postoperative liver injury was assessed by peak values of
AST and ALT, as well as the area under the curve (AUC) of the postoperative transaminase
course. Secondary end points included resection time, the need of blood transfusion, ICU and
hospital stay as well as postoperative complications and mortality.
Results: Both groups were comparable regarding demographics, ASA score, type of hepatectomy,
duration of inflow occlusion (range: 30-75 min), and resection surface. The transectionrelated
blood loss was 146 vs. 250 ml (p=0.008), and when standardized to the resection
surface 1.2 vs. 1.8 ml/cm2 (p=0.01) for IP and IC, respectively. Although peak AST, AUCAST,
and AUCALT were lower for IC, the differences did not reach statistical significance. Overall
(42 vs. 38%) and major (33 vs. 27%) postoperative complications as well as median ICU (1
vs. 1 d) and hospital stay (10 vs. 11 d) were similar between both groups.
Conclusion: Both IP and IC appear to be equally effective in protecting against postoperative
liver injury in non-cirrhotic patients undergoing major liver resection. However, IP is associated
with lower blood loss and shorter resection time. Therefore, both strategies can be recommended
for non-cirrhotic patients undergoing liver resection.
33.16
G. Balsano 1 , R.E. Vandoni 2 , A.C. Guerra 1 , B. Fournier 3 , P. Gertsch 4
1 Surgery, Ospedale San Giovanni, 6500 Bellinzona/CH, 2 Surgery, Ospedale San Giovanni,
6500 bellinzona/CH, 3 Soleggio, Ospedale San Giovanni, 6500 Bellinzona/CH, 4 Chirurgia,
Ospedale San Giovanni, 6500 Bellinzona/CH
Probability and risks of conversion in laparoscopic cholecystectomy for acute cholecystitis
Objective: Laparoscopic cholecystectomy is routinely performed for the treatment of acute
cholectystitis. We analysed retrospectively the results in our institution.
Methods: We included only patients with a histologically proven acute cholecystitis.
Experienced surgeons operated on all patients. Demographic data, time between onset of
symptoms and operation, laboratory findings, operation time, conversion to laparatomy, complications
and hospital stay were recorded and uni-and multivariate analysis performed.
Results: From January 1st, 2000 to December 31st, 2004, we included 108 patients
(55M/53F, mean age 61). One patient died of septic shock a few hours after operation and
one patient was reoperated on day 5 for an incisional occlusive hernia through a trocart incison.
One biliary leak was treated conservatively. Five minor complications were observed.
Conversion to laparotomy was performed in twenty-two patients (20%) for inflammatory status
(11 patients), adhesions (4 patients), haemorrhage (3 patients), bile duct stone (3
patients) and intolerance to pneumoperitoneum (1 patient). Factors associated with conversion
were: age (68±4 vs 59±2 years, p=0.03), longer delay between onset of symptoms and
operation (12±17.1 vs 38.2±34.6 hours, p=0.002) and higher C-reactive protein blood level
(142±22 vs 71±11 U/ml). These patients had a longer operation time (139±8 vs 95±4 min,
p