Article ; Online: Intraoperative Air Leak Test to Prevent Bile Leak After Right Posterior Sectionectomy with En Bloc Diaphragm Resection for Metastatic Teratoma.
2019 Volume 26, Issue 8, Page(s) 2579
Abstract: Background: The intraoperative air cholangiogram, or "air leak test" (ALT), at the time of hepatectomy can significantly reduce the rates of bile leak and symptomatic fluid collection after high-risk procedures.1: Presentation: The video presents the ...
| Abstract | Background: The intraoperative air cholangiogram, or "air leak test" (ALT), at the time of hepatectomy can significantly reduce the rates of bile leak and symptomatic fluid collection after high-risk procedures.1 Presentation: The video presents the case of a 29-year-old woman who had metastatic teratoma with an 8 × 7-cm liver metastasis in segment 7 and diaphragm invasion to the level of the right hepatic vein. Operation: The authors performed a formal right posterior sectionectomy with en bloc diaphragm resection. The 12 × 8-cm diaphragmatic defect was reconstructed using biologic mesh (Surgimend, Integra LifeSciences, Plainsboro, NJ). An intraoperative ALT (air injection into the cystic duct with finger compression of the distal bile duct) identified several areas of bubbles from biliary radicles on the cut surface of the liver, which were ligated with 4-0 polypropylene. The ALT was repeated until no bubbles remained. Because no evidence of bubbles was observed, no surgical drain was needed. The patient did well postoperatively with no complications. Conclusion: In cases of combined liver and diaphragmatic resection, prevention of bile leak, with subsequent contamination of the diaphragm repair and even the thoracic cavity, is particularly vital. An easily replicated intraoperative air leak test can mitigate the risk of bile leak and organ-space infection, as well as associated sequelae on quality of life, return to intended oncologic therapy, and oncologic outcomes. |
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| MeSH term(s) | Adult ; Anastomotic Leak/diagnosis ; Anastomotic Leak/surgery ; Common Bile Duct/injuries ; Common Bile Duct/surgery ; Female ; Hepatectomy/methods ; Humans ; Intraoperative Complications/diagnosis ; Intraoperative Complications/surgery ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery ; Postoperative Complications/prevention & control ; Prognosis ; Teratoma/pathology ; Teratoma/surgery |
| Language | English |
| Publishing date | 2019-05-07 |
| Publishing country | United States |
| Document type | Case Reports ; Journal Article |
| ZDB-ID | 1200469-8 |
| ISSN | 1534-4681 ; 1068-9265 |
| ISSN (online) | 1534-4681 |
| ISSN | 1068-9265 |
| DOI | 10.1245/s10434-019-07410-y |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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