The basic training in liver surgery on isolated perfused livers used at the workshop in the First Surgical Course of the Alps—Adriatic Hepatobiliary School is presented. The methods for the excision, preservation, perfusion and preparation of the liver are described, as is the manner of manufacturing the upper abdomen moulded casts, into which an isolated perfused liver is placed for training. The methods proved to be sufficiently successful, enabling participants to perform basic liver surgery like an intraoperative ultrasound investigation, as well as liver dissection techniques, liver suturing, segmental resection and even hepatectomy. Some technical improvements are proposed for future surgical workshops, such as washing out the blood from the liver, and a triple perfusion.

Gad&#x17e;ijev Eldar

Ravnik Dean

Sojar Valentin

Surgical Workshop on Liver Surgery Using Isolated Perfused Livers in Moulded Casts of the Upper Abdomen

This study evaluates the effect of oral pancreatic enzyme supplements on pain, analgesic requirementand the incidence of complications in patients with acute pancreatitis. This double blind, prospectivelyrandomised placebo controlled study included 23 patients. Pain was monitored using a visual analoguescale; the analgesic requirement was assessed with a numerical score.No significant differences were noted between the median (range) pain scores of patients whoreceived placebo: 22 (17.1&#8211;58) and those who received enzymes: 23 (11.3&#8211;63). Hospital stay was 7(5&#8211;10) days in patients on placebo and 8 (6&#8211;24) days in the enzyme group (p &#61; 0.069). Analgesicrequirements were: placebo 20 (6&#8211;60) and enzymes: 16 (0&#8211;63) (p &#61; 0.56). This study has shown nobeneficial effect of oral pancreatic enzyme supplements in the initial management of patients withacute pancreatitis.

R. V. Patankar

R.  Chand

C. D. Johnson

Pancreatic Enzyme Supplementation in Acute Pancreatitis

Despite numerous studies in the past it is not possible yet to predict postoperative liver failureand safe limits for hepatectomy. In this study the following liver function tests ICG-ER(indocyaninegreen elimination rate), GEC (galactose elimination capacity) and MEGX-F(monoethylglycinexylidid formation) are examined with regard to loss of liver tissue andprediction of operative risk. Liver function tests were assessed in 20 patients prior to liverresection and on the 10th. postoperative day. Liver and tumor volume were measured byultrasound and pathologic specimen and the parenchymal resection rate was calculated. Inpatients without cirrhosis (n &#61; 10) ICG-ER and MEGX-F remained unchanged afterresection, GEC was reduced but did not correspond to the resection rate. Patients withcirrhosis (n &#61; 10) had a significantly lower ICG-ER and GEC before resection than patientswithout cirrhosis. After resection these tests were unchanged. Patients with liver relatedcomplications and cirrhosis (n &#61; 5) had lower ICG-ER and GEC than patients with cirrhosisand no complications. In the postoperative course all liver function tests in these patients weresignificantly lower compared to preoperative results. Comparing liver function tests ICGserves best to indicate postoperative liver failure. Liver function tests do not correspond withloss of liver tissue.

Thomas  Zoedler

Christoph  Ebener

Heinz  Becker

Hans D. Roeher

Evaluation of Liver Function Tests to Predict Operative Risk in Liver Surgery

Percutaneous Transhepatic Biliary Drainage (PTBD) is performed in surgical jaundice todecompress the biliary tree and improve hepatic functions. However, the risk of sepsis is highin these patients due to immunosuppression and surgical outcome remains poor. This raises aquestion&#8212;can we do away with PTBD&#63; To answer this query a study was carried out in 4groups of patients bearing in mind the high incidence of sepsis and our earlier studies, whichhave demonstrated immunotherapeutic potential of Tinospora cordifolia (TC): (A) thoseundergoing surgery without PTBD (n &#61; 14), (B) those undergoing surgery after PTBD(n &#61; 13). The mortality was 57.14&#37; in Group A as compared to 61.54&#37; in Group B. Serialestimations of bilirubin levels carried out during the course of drainage (3 Wks) revealed agradual and significant decrease from 12.52 &#177; 8.3 mg&#37; to 5.85 &#177; 3.0 mg&#37;. Antipyrine half-lifedid not change significantly (18.35 &#177; 4.2 hrs compared to basal values 21.96 &#177; 3.78 hrs). Thephagocytic and intracellular killing (ICK) capacities of PMN remained suppressed (Basal:22.13 &#177; 3.68&#37; phago, and 19.1 &#177; 4.49&#37; ICK; Post drainage: 20 &#177; 8.48&#37; Phago and 11.15 &#177; 3.05&#37; ICK). Thus PTBD did not improve the metabolic capacity ofthe liver and mortality washigher due to sepsis. Group (C) patientg received TC during PTBD (n &#61; 16) and Group (D)patients received TC without PTBD (n &#61; 14). A significant improvement in PMN functionsoccurred by 3 weeks in both groups (30.29 &#177; 4.68&#37; phago, 30 &#177; 4.84&#37; ICK in Group C and30.4 &#177; 2.99&#37; phago, 27.15 &#177; 6.19&#37; ICK in Group D). The mortality in Groups C and D was25&#37; and 14.2&#37; respectively during the preoperative period. There was no mortality aftersurgery. It appears from this study that host defenses as reflected by PMN functions play animportant role in influencing prognosis. Further decompression of the biliary tree by PTBDseems unwarranted.

R. D.  Bapat

N. N. Rege

R. S. Koti

N. K. Desai

S. A. Dahanukar

Can We Do Away With PTBD&#63;

Of 36 patients with carcinoma of the ampulla of Vater who underwent surgery between1971 and 1990, 31 had a radical operation. There was one operative death. The overall5- and 10-year survival rates were 56 and 37 per cent respectively. Survival wassignificantly influenced by tumour stage (p&#61;0.0002), lymph node sthtus (p&#61;0.006) andthe degree of differentiation of the lesion (P&#61;0.01). Three patients developed localrecurrence after local excision of the tumour. Local or hepatic recurrence was common,even 5 years after pancreatoduodenectomy (four of 18 patients who suffered relapse).Radical resection can be curative in selected patients with ampullary carcinoma but laterecurrence suggests the need for careful lifelong follow-up.

Steven M. Strasberg

Is Late Recurrence after Radical Resection for Ampullary Carcinoma A Problem&#63;

Teimuraz L. Pirtzchalava

Dmitry A. Granov

Pavel G. Tarazov

Activation of Liver Cirrhosis: Control by Lymphosorbtion

Alexej A. Polykarpov

Hypersplenism in Liver Cirrhosis: Is Conservative Treatment Still Best&#x3F;

The fibrolamellar variant of hepatocellular carcinoma (HCC) is an uncommon tumour with
distinctive clinical and histological features. Although the first case of fibrolamellar hepatocellular
carcinoma (FI-HCC) was described by Edmondson in 1956, and later confirmed in five
patients by Peters, the majority of reports followed those of Berman et al. and Craig et al. 1,2.A case of FI-HCC, which is rarely diagnosed in Mediterranean countries including Turkey,
is presented in the following report.

Ismail Arslan

K&#xF6;ksal &#xD6;ner

Sadik Kiliffturgay

Nihat Agar

Fahrettin Alpaslan

Fibrolamellar Hepatocellular Carsinoma &#x201C;It is not a Ordinary Case for Mediterranean Countries&#x201D;

Ricardo L. Rossi

Overview of Biliary Diseases

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