Liver Transplantation Using the Clamp and Run Technique Does Not Adversely Affect Patient Outcomes

Liver Transplantation Using the Clamp and Run Technique Does Not Adversely Affect Patient Outcomes

232 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS well matched age, tumor size and location, type of hepatic resecti...

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ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS

well matched age, tumor size and location, type of hepatic resection. Results: The mean operative time was similar in both groups (MC group: 253 min [174-323], Control group: 273 min [154-388]). The mean blood loss in MC group was less than Control group, with significance difference (174 ml [23-620] vs 286 ml [50-409], p < 0.05). Incidence of postoperative complication was similar in both groups. In MC group, minor bile leakage was observed in one patient, but no critical complication was occurred such as postoperative bleeding or liver abscess. Postoperative recurrence was occurred in 4 patients in MC group, however, local recurrence was not observed. Conclusion: US-guided Glissonean coagulation before transection made the area of discoloration on the liver surface obvious, and by this technique the inflow blood to the tumor was intercepted. Our procedure is feasible to perform anatomical resection safely and easily, and is possible to inhibit intrahepatic metastasis via portal flow during transection. 25.3. Liver Transplantation Using the Clamp and Run Technique Does Not Adversely Affect Patient Outcomes. J. J. Guiteau, R. T. Cotton, C. A. O’Mahony, J. A. Goss; Baylor College of Medicine, Houston, TX. It has been previously stated that utilizing the standard technique of orthotopic liver transplantation (OLT) without venovenous bypass (VVB) and resection of the vena cava may be associated with increased perioperative morbidity and mortality due to the cross clamping of the vena cava. Increased OR time, transfusion requirements intraop, and incidence of renal failure have all been cited as potential setbacks but in the current era of OLT it is still unclear if these findings are still valid. Aim: To report our center’s outcomes on use of standard OLT technique without VVB. Methods: IRB approval was obtained for chart review of pts having undergone OLT at our institution. We preliminarily screened all OLT pts at St.

Luke’s Episcopal Hospital, Houston from 1/1/06 to 12/31/06. Pretransplant demographics, intraop data, 24 hr, 7d, and 30d laboratory data, post-op outcomes including complications, and overall survival were collected. Acute renal failure was defined as Cr >1.5 mg/dL and 50% increase over baseline or new onset hemodialysis post-op. Overall survival was calculated using Kaplan Meier curves. All analysis was performed on SPSS 15 (SPSS: Chicago, Il). Results: 43 consecutive cases were identified. Pt demographics are displayed in Table 1. Median intraop values were as follows: OR time - 258 min., EBL - 900 mL, PRBCs-2U, colloid-1000 mL, and cell saver-250 mL. Mean laboratory values at 24 hr, 7d, and 30d were as follows: Cr (mg/dL)-1.43, 1.29, 1.3; T Bili(mg/dL)-3.99, 2.8, 0.98; INR-1.5, 1.04, 1; ALT (U/L)-652, 143, 44; AST (U/L)-1035, 51, 31; Plt (k/cu mm)94.9, 121.5, 262, and Alk Phos (U/L)-78, 128.4, 100. Pts meeting criteria for ARF at 24 hr, 7d, and 30d were 20.9%, 9.3%, and 11.6%. 11.6% of pts were new onset dialysis pts with none requiring long term dialysis. Two pts had to return to the OR post-operatively, one for bleeding and the other for a perforated viscus. The median length of stay was 7d and overall survival at 3yrs is 91.1%. Conclusion: The current review demonstrates that OLT in the current era can be performed using the standard technique without VVB with minimal post-op morbidity and mortality. 25.4. Classification of Invasive Procedures for Treating the Local Complications of Acute Pancreatitis. J. A. Windsor, B. Loveday, M. S. Petrov, S. Connor, J. Rossaak, A. Mittal, A. Phillips; University of Auckland, Auckland, New Zealand Introduction: Improving the effectiveness of communication by standardising terminology is a universal strategy to help prevent medical errors. The lack of an accepted system to classify the invasive procedures to treat the local complications of acute pancreatitis is an obstacle to sharing and aggregating data to compare interventions. A comprehensive and multidisciplinary classification of the procedures is required, with the objectives to standardise procedure descriptions, differentiate between dissimilar procedures, enable comparison of similar procedures, and facilitate communication between clinicians. The aim of this study was to develop such a classification and to determine its acceptability and reliability. Methods: Terminology from the International Classification of Diseases Procedure Coding System was used to develop a system that classifies procedures based on three key components: how the target lesion is visualised, the route taken to reach the target lesion, and the purpose of the procedure. Gastroenterologists, radiologists, and surgeons from three centres in New Zealand were asked to assess the new classification, and use it to classify published technique descriptions. Using a Likert scale, participants rated the clarity and ease of use of the classification, and its likely ability to reach its objectives. Inter-rater reliability was calculated for each component separately. Results: Fifteen technique descriptions were classified by 22 clinicians (6 gastroenterologists, 11 radiologists, 5 surgeons). The clarity and ease of use each received median scores of 4/5. The classification’s likely ability to reach its objectives received median scores of 4/5. Inter-rater reliability for the visualisation, route and purpose components of the classification were 0.73 (95% confidence interval, 0.63 to 0.82), 0.79 (0.70 to 0.87), and 0.64 (0.53 to 0.74) respectively. Conclusions: The proposed classification has substantial inter-rater reliability and high acceptability. It should enable effective communication between clinicians, and facilitate comparison of different invasive procedures. 25.5. Predictors of In-Hospital Mortality Following Cholecystectomy among Hospitalized Patients. S. Kuy; Medical College of Wisconsin, Milwaukee, WI Introduction: Gallstone disease is important, occurring in 20% of the US population and carrying the second highest economic burden (nearly $6.5 billion annually) among digestive diseases in the US. Though cholecystectomy is a common procedure, mortality remains