Browsing by Author "Briceno, Eduardo"

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    ADULT-TO-PEDIATRIC LIVING DONOR LIVER TRANSPLANT IN RECIPIENTS >20 KG: A CASE SERIES OF FULL LEFT LOBE GRAFTS
    (2024) Ortiz, Catalina; Meira-Jr, Jose Donizeti; Pattillo, Juan Carlos; Vinuela, Eduardo; Jarufe, Nicholas; Martinez, Jorge; Briceno, Eduardo; Dib, Martin
    BACKGROUND: Chile presents one of the lowest organ donation rates, resulting in pediatric Walter de Biase 1 , Claudemiro 1 , Eduardo Gu liver waitlist mortality rates up to 38.1%. Live donor liver transplantation is one of the main alternatives Fabricio Ferreira 3 ,Paulo 3 to decrease waitlist mortality, mostly utilized in our country for small children up to 20 kg. AIMS: The aim of this study was to report a three-case series of adult-to-pediatric living donor liver transplantation using a full left lobe graft. METHODS: We report three cases of children with more than 20 kg who received complete left hemi-grafts in different clinical scenarios. The indications and techniques- Racional: O tratamento de escolha para pacientes com hipertens & atilde;o portal adopted are discussed. RESULTS: Three children, two girls and one boy, aged 11, 7, and 3 years, esquistossom & oacute;tica com sangramento de varizes h a desconex & atilde;o & aacute;zigo-portal mais were transplanted. The indications for transplant were fulminant hepatitis of autoimmune etiology, esplenectomia (DAPE) associada & agrave; terapia endosc & oacute;pica. Porhm, estudos mostram aumento hepatoblastoma, and chronic liver failure due to autoimmune hepatitis, respectively. The evolution was satisfactory in all three children, and to date, all are well, approximately 12-24 months after the do calibre das varizes em alguns pacientes durante o seguimento em longo prazo. Objetivo: transplant. CONCLUSIONS: The use of a living donor left lateral segment (segments 2 and 3) has been Avaliar oimpactodaDAPE e tratamento endosc & oacute;picop & oacute;s-operat & oacute;rionocomportamento successfully employed in pediatric liver transplantation. However, it is only suitable for infants and lowdas varizes esof & aacute;gicas e recidiva hemorr & aacute;gica, de pacientes esquistossom & oacute;ticos. Mhtodos: weight children. This approach using the whole left hemi-liver graft contributes to the reduction of Foram estudados 36 com a cinco distribu & iacute;dos em small-for-size syndrome, mortality rate, and waiting times associated with deceased donors.
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    Analysis of the Extent of Liver Oncological Extended Resection for Incidental Gallbladder Cancer: How Much Is Too Much?
    (2023) Vega, Eduardo A.; Mellado, Sebastian; Chirban, Ariana M.; Panettieri, Elena; Sanhueza, Marcel; Mege, Rosemarie; Diaz, Cristian; Branes, Alejandro; Briceno, Eduardo; Vinuela, Eduardo
    Background. Liver resection is pivotal in treating incidental gallbladder cancer (IGBC). However, the adequate volume of liver resection remains controversial.
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    Laparoscopic Versus Open Distal Pancreatectomy: Comparative Analysis of Clinical Outcomes at a Single Institution
    (2018) Jarufe, Nicolas; Soto, Pedro; Ahumada, Vanessa; Pacheco, Sergio; Salinas, Jose; Galindo, Jose; Bachler, Jean-Phillipe; Achurra, Pablo; Rebolledo, Rolando; Guerra, Juan F.; Briceno, Eduardo; Martinez, Jorge
    Purpose:Undertake a comparison between laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for the management of benign and malignant lesions.Methods:A case series study of 93 consecutive patients subjected to a distal pancreatectomy for pancreatic tumors between 2001 and 2015. In each patient, clinical and surgical characteristic, postoperative course, histopathologic examination, and survival were analyzed.Results:LDP was associated with significantly less operative blood loss (50mL vs. 300mL; P<0.01), higher spleen preservation rate (52.6% vs. 19.2%; P<0.01) and shorter hospital stay (5d vs. 8d; P<0.01). In patients with adenocarcinoma, survival at 1 and 5 years were 63.5% and 15.9% in the ODP group versus 66.7% and 33.3% in the LDP group (P=0.43).Conclusions:LDP is a safe and feasible procedure for DP resections. LDP offers advantages over ODP in terms of reduction of operative blood loss, higher spleen preservation rate, and shorter hospital stay.
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    Liver resection for hepatolithiasis: A multicenter experience in Latin America
    (2023) Garcia, Daniel; Marino, Carlo; Coelho, Fabricio Ferreira; Rebolledo, Patricia; Achurra, Pablo; Fonseca, Gilton Marques; Kruger, Jaime A. P.; Vinuela, Eduardo; Briceno, Eduardo; D'Albuquerque, Luiz Carneiro; Jarufe, Nicolas; Martinez, Jorge A.; Herman, Paulo; Dib, Martin J.
    Background: Hepatolithiasis is a prevalent disease in Asia but rare in Western countries. An increasing number of cases have been reported in Latin America. Liver resection has been proposed as a definitive treatment for complete stone clearance. The aim of this study was to evaluate the postoperative out-comes of liver resection for the treatment of hepatolithiasis in 2 large hepatobiliary reference centers from South America.Methods: We conducted a retrospective descriptive analysis from patients with hepatolithiasis who underwent liver resection between November 1986 and December 2018, in 2 Latin-American centers in Chile and Brazil.Results: One hundred forty-nine patients underwent liver resection for hepatolithiasis (72 in Chile, 77 in Brazil). The mean age was 49 years and most patients were female (62.4%). Hepatolithiasis was localized in the left lobe (61.7%), right lobe (24.2%), and bilateral lobe (14.1%). Bilateral lithiasis was associated with higher incidence of preoperative and postoperative cholangitis (81% vs 46.9% and 28.6% vs 6.1%) and need for hepaticojejunostomy (52.4%). In total, 38.9% of patients underwent major hepatectomy and 14.1% were laparoscopic. The postoperative stone clearance was 100%. The 30-day morbidity and mortality rates were 30.9% and 0.7%, respectively. Cholangiocarcinoma was seen in 2 specimens, and no post-operative malignancy were seen after a median follow-up of 38 months. Fourteen patients (9.4%) had intrahepatic stones recurrence.Conclusions: Liver resection is an effective and definitive treatment for patients with hepatolithiasis. Bilateral hepatolithiasis was associated with perioperative cholangitis, the need for hepaticojejunostomy, and recurrent disease. Resection presents a high rate of biliary tree stone clearance and excellent long-term results, with low recurrence rates and low risk of malignancy.(c) 2022 Elsevier Inc. All rights reserved.
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    Portosystemic shunt surgery for severe portal hypertension due to portal thrombosis after bariatric surgery
    (2024) Reyes, Natalia; Jarufe, Alessandra; Briceno, Eduardo; Vinuela, Eduardo; Martinez, Jorge; Dib, Martin; Jarufe, Nicolas
    Portal vein thrombosis is a rare complication after laparoscopic sleeve gastrectomy, a widely performed bariatric surgery procedure. Occasionally, the development of portal vein thrombosis can progress to more severe conditions, including portal hypertension and cavernomatosis, thereby presenting a complex and challenging clinical scenario. The management of such complications often requires careful consideration; however, surgical intervention in the form of a splenorenal shunt is an exceptional indication. We present the case of a 33-year-old female patient who had previously undergone laparoscopic sleeve gastrectomy in 2014 and subsequently developed portal thrombosis, followed by cavernomatosis and associated complications of portal hypertension. A proximal splenorenal shunt procedure and splenectomy were successfully performed to manage portal hypertension. The presentation of this clinical case aims to contribute to the available evidence and knowledge surrounding this rare and challenging pathology.
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    Right Lobe Liver Donation After Bariatric Surgery. A Case Series of 4 Living Donors
    (2022) Garcia, Daniel; Riveros, Sergio; Ochoa, Gabriela; Rebolledo, Patricia; Achurra, Pablo; Briceno, Eduardo; Vinuela, Eduardo; Arab, Juan Pablo; Jarufe, Nicolas; Fernandes, Eduardo; Martinez, Jorge; Dib, Martin
    Background. The increasing prevalence of obesity and need for bariatric surgery as well as the expanding use of living donors for liver transplantation means that potential donors could present with this surgical history. We present 4 cases of liver donors with previous bariatric surgery in our living donor liver transplant program. Methods. A retrospective descriptive analysis of patients with a bariatric surgery history who underwent right hepatectomy in our living donor liver transplant program is presented. Results. Case 1: A 53-year-old man with body mass index (BMI) of 33 who underwent lapa-roscopic sleeve gastrectomy (LSG). Pretransplant BMI was 21.5. Case 2: A 46-year-old woman with a BMI maximum of 40.8 who underwent LSG and required conversion to Roux-en-Y gas-tric bypass. Pretransplant BMI was 35.1. Case 3: A 53-year-old woman with a BMI maximum of 31.6 who underwent LSG. Pretransplant BMI was 24.2. Case 4: A 38-year-old man with a BMI maximum of 41.5 who underwent Roux-en-Y gastric bypass 6 years before the hepatectomy. Pretransplant BMI was 29.4. No complications were observed. Average operative time was 367.5 minutes, with a hospital stay of 5.8 days and 100% graft survival to date. Discussion. Utilization of selected donors with previous bariatric surgery appears to be a safe option and increases the donor pool.
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    Risk factors for readmission after a cholecystectomy: a case-control study
    (2024) Garcia, Daniel; Pastore, Antonia; Rodriguez, Javier; Crovari, Fernando; Cerda, Jaime; Rebolledo, Patricia; Achurra, Pablo; Vinuela, Eduardo; Martinez, Jorge; Dib, Martin; Briceno, Eduardo
    Objective: The aim of this study was to assess the risk factors associated with 30 -day hospital readmissions after a cholecystectomy. Methods: We conducted a case-control study, with data obtained from UC-Christus from Santiago, Chile. All patients who underwent a cholecystectomy between January 2015 and December 2019 were included in the study. We identified all patients readmitted after a cholecystectomy and compared them with a randomized control group. Univariate and multivariate analyses were conducted to identify risk factors. Results: Of the 4866 cholecystectomies performed between 2015 and 2019, 79 patients presented 30 -day hospital readmission after the surgical procedure (1.6%). We identified as risk factors for readmission in the univariate analysis the presence of a solid tumor at the moment of cholecystectomy (OR = 7.58), high pre -operative direct bilirubin (OR = 2.52), high pre -operative alkaline phosphatase (OR = 3.25), emergency admission (OR = 2.04), choledocholithiasis on admission (OR = 4.34), additional surgical procedure during the cholecystectomy (OR = 4.12), and post -operative complications. In the multivariate analysis, the performance of an additional surgical procedure during cholecystectomy was statistically significant (OR = 4.24). Conclusion: Performing an additional surgical procedure during cholecystectomy was identified as a risk factor associated with 30 -day hospital readmission.
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    Trasplante hepático: Evolución, curva de aprendizaje y resultados después de los primeros 300 casos
    (2019) Francisco Guerra, Juan; Luis Quezada, Jose; Cancino, Alejandra; Arrese, Marco; Wolff, Rodrigo; Benitez, Carlos; Carlos Pattillo, Juan; Cristobal Gana, Juan; Concha, Mario; Cortinez, Luis; Vera, Magdalena; Miranda, Paula; Rubilar, Francisco; Troncoso, Andres; Briceno, Eduardo; Dib, Martin; Jarufe, Nicolas; Martinez, Jorge
    Background: Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer. Aim: To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. Material and Methods: Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed. Results: A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively. Conclusions: Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.
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    Type I choledochal cyst. Total laparoscopic resection and Roux-en-Y reconstruction to two separated ducts
    (2024) Reyes, Natalia; Sotomayor, Camila; Inzunza, Martin; Briceno, Eduardo; Vinuela, Eduardo; Martinez, Jorge; Jarufe, Nicolas
    A choledochal cyst is a rare condition that requires surgical treatment to prevent complications, such as obstructive jaundice, cyst rupture, cholangitis, and the risk of malignancy. Complete cyst excision is considered the best option, as it reduces the risk of inflammation and the development of cholangiocarcinoma. Therefore, cholecystectomy and complete cyst resection followed by reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice. We present a case (with video) that shows the complete resection of a type I choledochal cyst with Roux-en-Y reconstruction of two separate ducts since the right posterior duct reached the cyst independently. The laparoscopic approach offers all the advantages of mini-invasive surgery and better visualization of the structures; however, biliary reconstruction to fine ducts implies a surgical challenge that requires high training in mini-invasive surgery.
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    Vena cava thrombectomy in kidney cancer. Report of 32 nephrectomies
    (2022) Rojas, Pablo A.; Bravo, Juan Cristobal; Navarro, Renato; Villagran, Sofia; Zuniga, Alvaro; Troncoso, Pablo; Becker, Pedro; Briceno, Eduardo; Francisco, Ignacio F. San
    Background: Vena cava (VC) involvement in kidney tumors occurs in 4 to 10% of cases, and is associated with a higher mortality. Nephrectomy with thrombectomy of the VC, performed by a multidisciplinary team, improves survival. Aim: To report a series of consecutive nephrectomies with caval thrombectomy performed in an academic center. Patients and Methods: We report 32 patients with cT3b and 3c renal tumors, who underwent radical nephrectomy with VC thrombectomy between 2001 and 2021. A descriptive analysis of clinical, surgical and pathological variables was performed. Overall survival (OS) and cancer-specific survival (CSS) was calculated using Kaplan-Meier curves. Results: The mean tumor size was 9.7 cm. According to Mayo classification 3/32 (9%) patients had a type I thrombus, 10/32 (31%) had a type II thrombus, 8/32 (25%) had a type III thrombus, and 5/32 (16%) had a type IV thrombus. The mean bleeding was 2000 cc. There was one intraoperative death. Nineteen percent of patients had complications >= 3 according to Clavien-Dindo classification. Reoperations occurred in 9%. Pre and postoperative creatinine levels were 1.17 and 1.91 mg/dl respectively (p < 0.01). Pre and postoperative Hematocrit levels were 47.9 and 31% respectively (p = 0.02). Sixty six percent of tumors were clear cell renal cancer, 9% were papillary and 3% were chromophobic. Mean OS was 10 months. Two-year SCE was 40%. Conclusions: Our results are similar to those reported elsewhere. Despite being an unusual pathology, the surgical technique has been improving, thanks to the multidisciplinary work of urologists and surgeons.