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Delayed gastric emptying after living donor hepatectomy for liver transplantation.

Wang H, Griesemer AD, Parsons RF, Graham JA, Emond JC, Samstein B - Case Rep Transplant (2014)

Bottom Line: Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases.Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation.Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy.

View Article: PubMed Central - PubMed

Affiliation: Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA.

ABSTRACT
Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases. Although the mechanism of posthepatectomy delayed gastric emptying remains unknown, vagal nerve injury during intraoperative dissection and adhesion formation postoperatively between the stomach and cut liver surface are possible explanations. Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation. Additionally, we also present a case in which symptoms developed after open right hepatectomy, but for which dissection for left hepatectomy was first performed. Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan of the abdomen with intravenous contrast for patient KS, one month following open right hepatectomy. There is no evidence of adhesion formation between the stomach and cut liver surface. The stomach (black arrow) is far removed from the cut surface of the liver.
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fig1: Computed tomography scan of the abdomen with intravenous contrast for patient KS, one month following open right hepatectomy. There is no evidence of adhesion formation between the stomach and cut liver surface. The stomach (black arrow) is far removed from the cut surface of the liver.

Mentions: KS, a 31-year-old woman with mild gastroesophageal reflux disease requiring no home medications, presented for planned open left hepatectomy (our preferred technique at the time) for liver donation. During the procedure, a replaced left hepatic artery was visualized and dissected to the level of its origin from the left gastric artery. To completely mobilize the replaced artery, neurovascular branches supplying the lesser curvature of the stomach were divided. Upon examination of the hepatic hilum, a standard left hepatic artery was found, as well as a small segment-4 artery from the proximal right hepatic artery. These additional arteries were not seen on preoperative imaging. Due to concern for increased risk of graft failure, the decision was made to convert to a right hepatectomy. The operation proceeded without complications. After removal of the right lobe graft, omentum and colon were placed in the resection bed, and Seprafilm adhesion barrier was applied to the cut liver surface. During the first postoperative week, the patient complained of nausea, heartburn, reflux, and nonbilious vomiting. The patient gradually improved with medical management including a proton pump inhibitor, sucralfate, and metoclopramide, and she was discharged home on postoperative day (POD) 9. On POD 31, the patient was readmitted for severe nausea, bilious vomiting, and burning epigastric pain. A computed tomography (CT) scan of the abdomen did not suggest bowel obstruction or adhesion formation between the stomach and cut liver surface (Figure 1). Endoscopy revealed retained food products in the stomach, and a gastric emptying study demonstrated absent emptying over one hour (Figure 2). Following initial improvement with medical management as described above, the patient experienced worsening emesis on POD 43 with solid food trial. During repeat endoscopy, 200 units of botulinum toxin were injected at the pylorus. Afterward, the patient experienced no further emesis and tolerated oral medications. An upper gastrointestinal series with small bowel follow-through showed no abnormalities. The patient was discharged home on POD 49. She underwent a repeat gastric emptying study one week after discharge, which showed marked improvement and normal gastric emptying (Figure 3). In subsequent follow-up, she reports feeling well and eating normally. She is currently over four years postdonation.


Delayed gastric emptying after living donor hepatectomy for liver transplantation.

Wang H, Griesemer AD, Parsons RF, Graham JA, Emond JC, Samstein B - Case Rep Transplant (2014)

Computed tomography scan of the abdomen with intravenous contrast for patient KS, one month following open right hepatectomy. There is no evidence of adhesion formation between the stomach and cut liver surface. The stomach (black arrow) is far removed from the cut surface of the liver.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4291134&req=5

fig1: Computed tomography scan of the abdomen with intravenous contrast for patient KS, one month following open right hepatectomy. There is no evidence of adhesion formation between the stomach and cut liver surface. The stomach (black arrow) is far removed from the cut surface of the liver.
Mentions: KS, a 31-year-old woman with mild gastroesophageal reflux disease requiring no home medications, presented for planned open left hepatectomy (our preferred technique at the time) for liver donation. During the procedure, a replaced left hepatic artery was visualized and dissected to the level of its origin from the left gastric artery. To completely mobilize the replaced artery, neurovascular branches supplying the lesser curvature of the stomach were divided. Upon examination of the hepatic hilum, a standard left hepatic artery was found, as well as a small segment-4 artery from the proximal right hepatic artery. These additional arteries were not seen on preoperative imaging. Due to concern for increased risk of graft failure, the decision was made to convert to a right hepatectomy. The operation proceeded without complications. After removal of the right lobe graft, omentum and colon were placed in the resection bed, and Seprafilm adhesion barrier was applied to the cut liver surface. During the first postoperative week, the patient complained of nausea, heartburn, reflux, and nonbilious vomiting. The patient gradually improved with medical management including a proton pump inhibitor, sucralfate, and metoclopramide, and she was discharged home on postoperative day (POD) 9. On POD 31, the patient was readmitted for severe nausea, bilious vomiting, and burning epigastric pain. A computed tomography (CT) scan of the abdomen did not suggest bowel obstruction or adhesion formation between the stomach and cut liver surface (Figure 1). Endoscopy revealed retained food products in the stomach, and a gastric emptying study demonstrated absent emptying over one hour (Figure 2). Following initial improvement with medical management as described above, the patient experienced worsening emesis on POD 43 with solid food trial. During repeat endoscopy, 200 units of botulinum toxin were injected at the pylorus. Afterward, the patient experienced no further emesis and tolerated oral medications. An upper gastrointestinal series with small bowel follow-through showed no abnormalities. The patient was discharged home on POD 49. She underwent a repeat gastric emptying study one week after discharge, which showed marked improvement and normal gastric emptying (Figure 3). In subsequent follow-up, she reports feeling well and eating normally. She is currently over four years postdonation.

Bottom Line: Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases.Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation.Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy.

View Article: PubMed Central - PubMed

Affiliation: Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA.

ABSTRACT
Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases. Although the mechanism of posthepatectomy delayed gastric emptying remains unknown, vagal nerve injury during intraoperative dissection and adhesion formation postoperatively between the stomach and cut liver surface are possible explanations. Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation. Additionally, we also present a case in which symptoms developed after open right hepatectomy, but for which dissection for left hepatectomy was first performed. Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy.

No MeSH data available.


Related in: MedlinePlus