References of "Acta Chirurgica Belgica"
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See detailWhat you should know before starting minimal invasive liver resection: an overview
DETRY, Olivier ULg

in Acta Chirurgica Belgica (2014, May), 114(3), 117

Laparoscopic liver surgery has evolved over the last 2 decades. Advancements in surgical technology, surgical technique, and postoperative care have aided in lifting barriers to laparoscopic liver ... [more ▼]

Laparoscopic liver surgery has evolved over the last 2 decades. Advancements in surgical technology, surgical technique, and postoperative care have aided in lifting barriers to laparoscopic liver resections (LLR). LLR might decrease morbidity and hospitalisation stay compared to open approach, and importantly in liver surgery, may decrease postoperative costal pain. However, in hepatic surgery as in all abdominal procedures, laparoscopic approach is a mean but not a goal. The possibility of LLR should neither modify indications for surgery nor the type of resection. Physiologic modifications induced by CO2 pneumoperitoneum should be known by the surgical and anaesthetic team involved in LLR. Pneumoperitoneum decreases cardiac output, and this decrease could be worsened by the reverse Trendelenburg position and by hepatic hilar clamping. CO2 pneumoperitoneum decreases hepatic blood flow. This is a clear advantage for limiting blood loss during LLR, but this also might increase liver ischemia during Pringle liver hilum clamping, a manoeuvre that should be avoided in LLR. Low venous pressure might decrease blood loss by the small supra hepatic veins, but may also further decrease cardiac output. Several devices may be used for liver section, without evidence of the superiority of one device compared to others. Endo GIA might be very helpful to control the major liver vessels, as branches of portal vein or suprahepatic veins. Significant CO2 embolism is a rare complication, and conversion to open approach for haemorrhage should be performed only if blood loss is controlled. Up to now, there is no clear scientific evidence that laparoscopic approach provides any advantage compared to open approach. SILS, LESS or even robotic approaches should only considered as purely experimental. Current barriers to LLR will continue to fall in the future. [less ▲]

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See detailIs ultra-short cold ischemia the key to ischemic cholangiopathy avoidance in DCD-LT?
DETRY, Olivier ULg; DE ROOVER, Arnaud ULg; Cheham, S et al

in Acta Chirurgica Belgica (2013, May), Supplement 113(3), 6729

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See detailResults of kidney transplantation from controlled donors after cardio-circulatory death: a single center experience
Le Dinh, Hieu ULg; WEEKERS, Laurent ULg; BONVOISIN, Catherine ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 667

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival ... [more ▼]

Objectives: The aim of this study was to determine results of kidney transplantation (KT) from controlled donation after cardio-circulatory death (DCD). Primary end-points were graft and patient survival, and post-transplant complications. The influence of delayed graft function (DGF) on graft survival and DGF risk factors were analyzed as secondary end-points. Methods: This is a retrospective mono-center review of a consecutive series of 80 DCD-KT performed at the University Hospital of Sart Tilman, University of Liège, between Jan 2005 and Dec 2011. Mean patient follow-up was 28.5 months. Results: Overall graft survival was 93.7%, 89.5%, 85% and 81.3% at 3 months, 1 year, 3 and 5 years, respectively. Death-censored graft survival at the corresponding time points was 93.7%, 93.7%, 90.8% and 90.8%. Main cause of graft loss was patient’s death with a functioning graft. No primary non-function grafts were encountered. Renal graft function was suboptimal at hospital discharge, but nearly normalized at 3 months. DGF was observed in 36% of all DCD-KT. DGF significantly increased post-operative length of hospitalization, but had no deleterious impact on graft function or survival. Donor body mass index (BMI) ≥30 kg/m2, recipient BMI ≥30 kg/m2 and pre-transplant dialysis duration significantly increased the risk of DGF in a multivariate logistic regression analysis (p < 0.05). Conclusions: Despite a higher rate of DGF, controlled DCD-KT offers a valuable contribution to the pool of deceased donor kidney grafts, with comparable mid-term results to those procured after brain death. [less ▲]

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See detailLiège experience in donation after cardiac death liver transplantation: 2003-2011
Le Dinh, Hieu ULg; DELWAIDE, Jean ULg; MONARD, Josée ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 6811

Objectives: Results of DCD-LT at the University Hospital of Liège were evaluated from 2003 to 2011. Methods: Medical records of 56 DCD liver recipients were retrospectively reviewed with regard to patient ... [more ▼]

Objectives: Results of DCD-LT at the University Hospital of Liège were evaluated from 2003 to 2011. Methods: Medical records of 56 DCD liver recipients were retrospectively reviewed with regard to patient and graft survivals and biliary complications. Mean follow-up was 26.4 months. Mean donor age was 56.3±14.5 years (25 - 83). Donor causes of death were due to anoxia (51.8%), stroke (32.1%) and head trauma (14.3%). Mean WIT, CIT and suture time were 20.5±7.1min (10 – 39), 265.6±85.1min (105 – 576), and 40.8±7.8 min (25 – 61), respectively. 95% of liver grafts were locally shared. HTK was the most commonly used perfusion solution (86%). Mean recipient age was 56.6±10.5 years (29 – 73). Indications for LT included ESLD (53.6%) and HCC (46.6%). Mean MELD score at transplant was 15.6±6.1points (6 – 40). Results: No primary non-function grafts. Mean peak serum AST and bilirubin levels were 2520±3621UI/L and 50.2±49.2mg/L, respectively. Eight patients (14.3%) developed biliary complications. No intra-hepatic bile duct strictures or re-transplantation. Global patient and graft survival was 92.6% at 3 months, 92.6% at 1 year, 73.8% at 3 years and 60% at 5 years. Death-censored patient and graft survival at the corresponding time points was 92.6%, 92.6%, 87.7% and 87.7%. Thirteen liver grafts were lost during follow-up exclusively due to recipient deaths. The rate of HCC recurrence was 33.3%. Conclusions: Controlled DCD donors are a valuable source of transplantable liver grafts. Primary results are encouraging and apparently as good as those from brain-dead donation LT essentially due to short WIT and CIT. [less ▲]

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See detailINTRA-TUMORAL HETEROGENEITY AND RATIONAL SELECTION OF ANTIGENS FOR TARGETED THERAPY OF LIVER METASTASES
Turtoi, Andrei ULg; Blomme, Arnaud ULg; Delvaux, David ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 8953

Objectives: Targeted therapies of liver metastases are gaining a major stake in current and future treatment options. However, the malignant lesions are heterogeneous in nature offering niches for cancer ... [more ▼]

Objectives: Targeted therapies of liver metastases are gaining a major stake in current and future treatment options. However, the malignant lesions are heterogeneous in nature offering niches for cancer cells causing treatment resistance and relapse. Therefore, a rational strategy is needed to select targetable antigens that would overcome this intra-tumoral heterogeneity. Methods: After ethical committee approval, 48 fresh liver metastases of colorectal origin were prospectively collected from patients undergoing liver resection. Here we macroscopically divided the lesion in different zones and generated a unique quantitative picture of the proteome heterogeneity in colorectal carcinoma liver metastases. Particular focus was laid on accessible proteins, a protein subclass comprising cell membrane associated and extracellular proteins. Accordingly, the tissues were ex-vivo biotinylated, affinity purified and analyzed for each zone separately using nano-UPLC-MSe proteomics technique. In total over 1500 unique proteins were statistically divided into different patterns of expression. Results: We have generated a quantitative picture of the proteome heterogeneity in colorectal carcinoma liver metastases. The study offers insight into novel targets but also antigens against which the antibodies are already involved in clinical trials or treatment of liver metastases. Extensive clustering and validation experiments highlight novel markers that offer the potential to homogeneously cover the metastatic lesion and become better targets. Conclusions: Two such antigens, LTBP2 and TGFBI were selected for functional analysis in colorectal carcinoma cells. In vitro and in vivo experiments showed that in particular TGFBI is relevant for migration and proliferation capacity of colorectal cancer cells. The suppression of this protein led to significant inhibition of tumor growth, crystalizing it as bona fide target for the development of anti-metastases therapies. [less ▲]

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See detailDREAM 2012: DEVELOPMENT OF LAPAROSCOPIC SURGERY AT THE UNIVERSITY HOSPITAL OF KINSHASA, DRC
Nsadi Fwene, Berthier ULg; Veyi, D; Kazadi, J et al

in Acta Chirurgica Belgica (2012, May), 112(3), 8240

Objectives: The technical nature of laparoscopy, and the required specific laparoscopic tools and medical skills, may render this approach difficult in developing countries. We hypothesized that ... [more ▼]

Objectives: The technical nature of laparoscopy, and the required specific laparoscopic tools and medical skills, may render this approach difficult in developing countries. We hypothesized that laparoscopy may be developed in the Cliniques Universitaires de Kinshasa (CUK), and may be cost-effective. The final aim of this program is to bring the benefits of laparoscopy to the DRC population, by allowance of adequate training on the UNIKIN personnel, including anaesthetists, surgeons and nurses, who in the future will have to locally form the DRC medical and nursery students. Methods: With the financial support from Wallonie-Bruxelles International (WBI), a complete CUK team, including a surgeon (2 years training in Belgium), an anaesthetist and nurses, were trained in Belgium and then afterwards in DRC. The laparoscopic equipment was sent to Kinshasa, and three theoretical and practical missions of Belgian teams were organised. Results: Over a 2 year period, 116 laparoscopic procedure were performed, including 32 appendectomies, 41 cholecystectomies, 11 hernia repairs, 9 laparoscopy explorations for peritoneal carcinoma assessment and biopsy, 8 procedures for catheter of dialysis peritoneal, 5 gynecologics procedures, and 10 other miscellaneous procedures. Conclusions: A joined approach, taking into account on one hand the training of the skills locally trained to adapt itself to some difficulties, on the other hand institutions of scientific support and a real program and local will of development of this new procedure are the wages of development, accessibility and durability of such news approach in developing countries. All University and non-University team willing to join such a project are welcome. [less ▲]

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See detailINTRAPERITONEAL ADHESIONS AFTER OPEN OR LAPAROSCOPIC ABDOMINAL PROCEDURE: AN EXPERIMENTAL STUDY IN THE RAT
Arung, Willy; Drion, Pierre ULg; CHERAMY-BIEN, Jean-Paul ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 8546

Objectives: Adhesion formation is common after abdominal surgery. The incidence and severity of adhesion formation following open or laparoscopic surgery remain controversial. The role of CO2 ... [more ▼]

Objectives: Adhesion formation is common after abdominal surgery. The incidence and severity of adhesion formation following open or laparoscopic surgery remain controversial. The role of CO2 pneumoperitoneum is also largely discussed. This study aimed to compare adhesion formation following peritoneal injury by electrocoagulation performed through open or laparoscopic procedures in a rat model. Methods: Sixty male rats were randomized to undergo a 1.5cm peritoneal injury with unipolar cautery under general anesthesia: open surgery (group A, n=20), laparoscopic surgery with CO2 pneumoperitoneum (group B, n=20) and laparoscopic surgery with air pneumoperitoneum (group C, n=20). Duration of the procedures was fixed at 90 minutes in all groups, and pneumoperitoneum pressure at 10mmHg. Ten days later, the animals underwent a secondary laparotomy to score peritoneal adhesions using qualitative and quantitative parameters. Results: Forty-five rats developed at least one adhesion, respectively 95% in group A, 83% in group B and 55% in group C (P<0.01; Group C vs Group A, P<0.01). According to number, thickness, tenacity, vascularization, extent, type, and grading according to Zühkle classification, no significant difference was observed between groups A and B. The distribution of adhesions after open surgery was significantly different than after laparoscopic surgery (P<0.001). Interestingly, group C rats developed significantly less adhesions at the traumatized site, and their adhesions had less severe qualitative scores compared to open surgery (P<0.01). Conclusions: In this animal model, CO2 laparoscopic surgery did not decrease the formation of postoperative adhesion, compared to open surgery. The difference with the animals operated with air pneumoperitoneum emphasizes the role of CO2 in peritoneal injury leading to adhesion formation. [less ▲]

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See detailEFFECT OF PARECOXIB, A SELECTIVE COX-2 INHIBITOR, IN THE PREVENTION OF POSTOPERATIVE ADHESIONS IN A RAT MODEL
Arung Kalau, Willy ULg; Drion, Pierre ULg; CHERAMY-BIEN, Jean-Paul ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 8444

Objectives: Postoperative peritoneal adhesions are frequent after abdominal surgery. Many preventive agents have been tried in animal models and in clinical trials, but up to now, there has been no ... [more ▼]

Objectives: Postoperative peritoneal adhesions are frequent after abdominal surgery. Many preventive agents have been tried in animal models and in clinical trials, but up to now, there has been no definitive strategy to prevent their formation. In this study, the effectiveness of parecoxib (Dynastat®), a selective cyclooxygenase-2 inhibitor, in preventing experimental intra-abdominal adhesions in rats was studied. Methods: Thirty male rats who underwent a primary surgical procedure aiming at inducing peritoneal injury to produce intraabdominal adhesion, were randomized in three groups: (A) control group, no therapy; (B) intraperitoneal (IP) parecoxib group; (C) intramuscular (IM) parecoxib group. Ten days later, a xyphopubic midline incision was performed and the whole abdominal cavity was explored to score the peritoneal adhesions. Results: Twenty-three rats developed adhesions, 9 (100%) in group A, 7 (70%) in group B and 4 (40%) in group C (P=0.01). The extent and severity scores of adhesion were significantly lower in groups B and C than those in control group (p<0.001). Type of adhesions was measured at 2.25 ± 0.67 in group A, 1.20 ± 0.86 in group B and 0.82 ± 0.80 in group C. This was significantly different between group A and B (p<0.001), between A and C (p<0.001). But no significant difference was found between group B and C (p=0.17). Conclusions: In this study, we found a significant effect on parecoxib in the prevention of postoperative adhesions. But, without avoiding completely the formation of adhesion, parecoxib reduces significantly extent and severity of postoperative adhesions in rats treated with IP or IM parecoxib administration. [less ▲]

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See detailWhat is the potential increase of the heart graft pool by cardiac donation after circulatory death?
NOTERDAEME, Timothée; HANS, Marie-France ULg; NELLESSEN, Eric ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 668

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See detailLaparoscopic liver resection: a single center experience
SZECEL, Delphine ULg; DE ROOVER, Arnaud ULg; DELWAIDE, Jean ULg et al

in Acta Chirurgica Belgica (2012, May), 112(3), 631

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See detailCardiac paraganglioma : diagnostic work up and review of the literature.
Sooknunden, Marvyn ULg; HAMOIR, Etienne ULg; de Leval, Laurence ULg et al

in Acta Chirurgica Belgica (2012), 112

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See detailTiming of Carotid Endarterectomy : a Comprehensive Review
BRULS, Samuel ULg; VAN DAMME, Hendrik ULg; DEFRAIGNE, Jean ULg

in Acta Chirurgica Belgica (2012), 212

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See detailChoice of key-words for a scientific paper.
VAN DAMME, Hendrik ULg; DETRY, Olivier ULg; Lerut, J et al

in Acta Chirurgica Belgica (2012), 112(2), 107

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See detailSurgical treatment of cardiovascular complications in patients with Marfan syndrome: a report of two cases and literature review.
BRULS, Samuel ULg; BRULS, Samuel ULg; Radermecker, Marc ULg et al

in Acta Chirurgica Belgica (2012), 112(3), 213-8

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or ... [more ▼]

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or rupture. It can be prevented by regular aortic follow-up and prophylactic aortic surgery. Modern aortic surgery has led to a substantial increase in the life expectancy of these patients. We report two cases of Marfan syndrome with cardiovascular complications. Their management is discussed according to the most recent literature. [less ▲]

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See detailEsophageal cancer surgery in patients older than 75: long term results.
HONORE, Charles ULg; Al-Azzeh, Ali ULg; GILSON, Nathalie ULg et al

in Acta Chirurgica Belgica (2011), 111(1), 12-7

PURPOSE: The purpose of this study was to evaluate short and long term results after esophageal cancer resection in patients older than 75. METHODS: We retrospectively analyzed the database of esophageal ... [more ▼]

PURPOSE: The purpose of this study was to evaluate short and long term results after esophageal cancer resection in patients older than 75. METHODS: We retrospectively analyzed the database of esophageal cancer surgically treated in our department between January 2003 and December 2009 to identify patients older than 75. The preoperative, operative, postoperative and long term characteristics were analyzed. RESULTS: Among 137 patient, 23 were older than 75. The histological subtype was adenocarcinoma in 100%. The surgical techniques were a "Lewis-Santy" procedure in 43%, a trans-hiatal resection in 22%, a "Sweet" procedure in 13%, a stripping in 13% and a McKeown procedure in 9%. The in-hospital postoperative mortality was 13%. The in-hospital postoperative morbidity (Dindo-Clavien Grade >2, deceased patients included) was 26%. In univariate analysis, no statistically significant risk factor of morbidity was found. A Charlson Comorbidity Index >2 was, in univariate analysis, the sole risk factor of postoperative mortality (p = 0.0362). The mean hospital stay was 22 +/- 12 days. The median survival was 24.2 months. The 5-year overall survival was 39% and the 5-year disease free survival was 26%.57% of long-term deaths were not cancer related. CONCLUSION: Esophageal surgery performed in selected patients older than 75 has an acceptable morbidity and mortality but when a severe complication occurs, it leads to death in half of the cases. Surgery enables a long term survival benefit. This study confirmed our attitude of not considering age as a contra-indication for esophageal surgery but rather considering general status, self-reliance and associated comorbidities for patients' selection. [less ▲]

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See detailEndoscopy and Surgery: A Matter of Diagnostic Enlightenment & Therapeutic Liberty
Bertrand, Cl; Burnon, D.; Carly, B. et al

in Acta Chirurgica Belgica (2011), 111(4), 200-204

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See detailConsequences of laparoscopy on liver ischemia during portal triad clamping in a swine model
Nsadi, Berthier; Pire, E.; Gilson, Nathalie ULg et al

in Acta Chirurgica Belgica (2010, April), 110

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See detailDonation after Cardiac Death In Liver Transplantation :is donor age an issue?
Detry, Olivier ULg; De Roover, Arnaud ULg; Squifflet, Jean-Paul ULg et al

in Acta Chirurgica Belgica (2010, April), 110

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