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Article: Fluorescence imaging in hepatobiliary surgery - hope and hype.

Iyer, Shridhar Ganpathi

2021 Volume 62, Issue 4, Page(s) 157–158

MeSH term(s)	Hope ; Humans ; Optical Imaging
Language	English
Publishing date	2021-03-20
Publishing country	Singapore
Document type	Editorial ; Comment
ZDB-ID	604319-7
ISSN	0037-5675
ISSN	0037-5675
DOI	10.11622/smedj.2021035
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Zs.B 589: Show issues

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Article: Retained stone retrieval basket causing chronic pancreatitis: a case report.

Lee, James Wai Kit / Tan, Ming Yuan / Koh, Calvin / Iyer, Shridhar Ganpathi / Gao, Yujia

Frontiers in surgery

2023 Volume 10, Page(s) 1235833

Abstract: Background: Endoscopic retrograde cholangiopancreatography is a common procedure performed for choledocholithiasis and gallstone pancreatitis. Although a relatively low risk procedure, it is not without its complications. Cases of impacted Dormia ... ...

Abstract	Background: Endoscopic retrograde cholangiopancreatography is a common procedure performed for choledocholithiasis and gallstone pancreatitis. Although a relatively low risk procedure, it is not without its complications. Cases of impacted Dormia baskets during stone retrieval have been reported, but these are usually retrieved surgically during the same setting. Case summary: A 40-year-old man presented to our hospital with an episode of epigastric pain and discomfort. He has a prior background of recurrent episodes of pancreatitis of which he underwent prior endoscopic therapy in his home country. Initial investigations revealed a metallic object seen on abdominal x-ray, computer tomographic scan of the abdomen and pelvis, and magnetic resonance imaging of the pancreas. Further evaluation was done with endoscopy, which revealed a retained stone extraction basket from a previous endoscopic retrograde pancreatography, resulting in recurrent episodes of acute chronic pancreatitis. Although the retained foreign body was removed, he subsequently developed further complications of portal vein thrombosis as a result of recurrent acute chronic pancreatitis, which required anticoagulation. Conclusion: This case highlights the importance of retrieving any foreign body from the pancreas, especially on the head, to prevent the development of further complications.
Language	English
Publishing date	2023-08-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2023.1235833
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Article ; Online: Liver Transplantation in Singapore: Challenges and Strategies of Low- to Mid-volume Centers.

Yeow, Marcus / Bonney, Glenn Kunnath / Kow, Wei Chieh Alfred / Wee, Priscilla / Madhavan, Krishnakumar / Iyer, Shridhar Ganpathi

Transplantation

2022 Volume 106, Issue 5, Page(s) 895–897

MeSH term(s)	Hospital Mortality ; Hospitals, Special ; Liver Transplantation ; Singapore
Language	English
Publishing date	2022-04-26
Publishing country	United States
Document type	Editorial
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000003925
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Article ; Online: Locally invasive recurrence or metastasis of pheochromocytoma into the liver?-clinicopathological challenges.

Tang, Sarah S / Lee, James W K / Wijerethne, Sujith / Iyer, Shridhar Ganpathi / Hue, Susan / En, Nga Min / Parameswaran, Rajeev

World journal of surgical oncology

2022 Volume 20, Issue 1, Page(s) 360

Abstract: Pheochromocytomas (PCC) are rare and functional neuroendocrine tumors developing from adrenal chromaffin cells. Predicting malignant behavior especially in the absence of metastasis can be quite challenging even in the era of improved understanding of ... ...

Abstract	Pheochromocytomas (PCC) are rare and functional neuroendocrine tumors developing from adrenal chromaffin cells. Predicting malignant behavior especially in the absence of metastasis can be quite challenging even in the era of improved understanding of the molecular mechanisms involved in PCCs. Currently, two histopathological grading systems Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) and Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) score are used in clinical practice, but these are subject to significant interobserver variability. Some of the most useful clinical factors associated with malignancy are large size ([4-5 cm), and genetic features such as presence of SDHB germline mutations. Local invasion is uncommon in PCC and metastasis seen in 10 to 17% but higher in germline mutations and when this occurs management can be challenging. Here, we report on a case with challenges faced by the pathologist and clinicians alike in diagnosis and management of PCC recurrence.
MeSH term(s)	Humans ; Pheochromocytoma/surgery ; Adrenal Gland Neoplasms/pathology ; Paraganglioma/diagnosis ; Paraganglioma/genetics ; Paraganglioma/pathology ; Germ-Line Mutation ; Liver/pathology
Language	English
Publishing date	2022-11-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2118383-1
ISSN	1477-7819 ; 1477-7819
ISSN (online)	1477-7819
ISSN	1477-7819
DOI	10.1186/s12957-022-02817-6
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Article: Safely Implementing a Program of Pure Laparoscopic Donor Right Hepatectomy: The Experience From a Southeast Asian Center.

Law, Jia-Hao / Tan, Chun Han Nigel / Tan, Kah Hwee Jarrod / Gao, Yujia / Pang, Ning Qi / Bonney, Glenn Kunnath / Iyer, Shridhar Ganpathi / Soubrane, Olivier / Kow, Wei Chieh Alfred

Transplantation direct

2023 Volume 9, Issue 6, Page(s) e1486

Abstract: Laparoscopic donor right hepatectomy (LDRH) is a technically challenging procedure. There is increasing evidence demonstrating the safety of LDRH in high-volume expert centers. We report our center's experience in implementing an LDRH program in a small- ...

Abstract	Laparoscopic donor right hepatectomy (LDRH) is a technically challenging procedure. There is increasing evidence demonstrating the safety of LDRH in high-volume expert centers. We report our center's experience in implementing an LDRH program in a small- to medium-sized transplantation program. Methods: Our center systematically introduced a laparoscopic hepatectomy program in 2006. We started with minor wedge resections followed by major hepatectomies with increasing complexities. In 2017, we performed our first laparoscopic living donor left lateral sectionectomy. Since 2018, we have performed 8 cases of right lobe living donor hepatectomy (laparoscopy-assisted: 4 and pure laparoscopic: 4). Results: The median operative time was 418 (298-540) min, whereas the median blood loss was 300 (150-900) mL. Two patients (25%) had surgical drain placed intraoperatively. The median length of stay was 5 (3-8) d, and the median time to return to work was 55 (24-90) d. None of the donors sustained any long-term morbidity or mortality. Conclusions: Small- to medium-sized transplant programs face unique challenges in adopting LDRH. Progressive introduction of complex laparoscopic surgery, a mature living donor liver transplantation program, appropriate patient selection, and the invitation of an expert to proctor the LDRH are necessary to ensure success.
Language	English
Publishing date	2023-05-24
Publishing country	United States
Document type	Journal Article
ISSN	2373-8731
ISSN	2373-8731
DOI	10.1097/TXD.0000000000001486
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Article ; Online: Evaluation of Adult Living Donor Liver Transplantation in Largest Southeast Asian Transplantation Center: Benchmarking With Adult-to-Adult Living Donor Liver Transplantation (A2ALL) Experience.

Yeow, Marcus / Pang, Ning-Qi / Chen, Zhaojin / Wee, Priscilla / Bonney, Glenn Kunnath / Madhavan, Krishnakumar / Kow, Wei Chieh Alfred / Iyer, Shridhar Ganpathi

Transplantation proceedings

2021 Volume 53, Issue 10, Page(s) 2953–2962

Abstract: Background: The volume-outcome relation for complex surgical procedures such as living donor liver transplantation (LDLT) generally favors high volume (HV) centers. It is important for low to medium volume (MV) centers to evaluate their centers' ... ...

Abstract	Background: The volume-outcome relation for complex surgical procedures such as living donor liver transplantation (LDLT) generally favors high volume (HV) centers. It is important for low to medium volume (MV) centers to evaluate their centers' performance against HV centers to allow early detection and correction of potential systemic issues. There is a dearth of national and international comprehensive registries for LDLT that may allow reasonable risk-adjusted comparisons for benchmarking. This study aims to evaluate the LDLT program by comparing our center's performance against HV centers of the Adult-to-Adult Living Donor Liver Transplantation cohort. Study design: Patient outcomes from a MV transplant center were compared with 11 HV transplant centers from the Adult-to-Adult Living Donor Liver Transplantation cohort. Outcomes evaluated included length of hospital stay, same admission mortality, 90-day mortality, and overall survival. Results: A total of 1381 patients were analzyed. HV 1 to 4, 6, 8, 9, and 11 centers had a shorter median length of hospital stay compared with the MV center (All Dunnett corrected P values all less than .05). HV 9 and 11 centers had lower same admission mortality compared with the MV center (Dunnett corrected P = .023 and .015). After adjusting for other significant predictors, the MV center had comparable 90-day mortality rates and overall survival rates to all HV centers. Conclusion: This benchmarking exercise has demonstrated that the limitation of low institutional case volume can be overcome with a protocol-based framework to implement a safe LDLT program. This framework presented can be adopted for developing programs.
MeSH term(s)	Adult ; Benchmarking ; Humans ; Liver Transplantation ; Living Donors ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-11-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2021.09.046
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Article ; Online: Living donor hepatectomy in medium volume liver transplant centre has comparable outcomes to high volume centres: validation of donabedian quality assurance framework.

Yeow, Marcus Wei Xuan / Pang, Ning Q / Bonney, Glenn K / Madhavan, Krishnakumar / Kow, Wei Chieh Alfred / Iyer, Shridhar Ganpathi

HPB : the official journal of the International Hepato Pancreato Biliary Association

2021 Volume 24, Issue 4, Page(s) 516–524

Abstract: Background: Given the complexity of living donor hepatectomy, it is expected that high hospital volume will better outcomes. This study aims to evaluate post-operative outcomes for living donor hepatectomy in a medium volume liver transplant centre and ... ...

Abstract	Background: Given the complexity of living donor hepatectomy, it is expected that high hospital volume will better outcomes. This study aims to evaluate post-operative outcomes for living donor hepatectomy in a medium volume liver transplant centre and compare to outcomes in high volume centres. Also, it serves as a validation tool for framework of structure-process-outcome model for safe living donor hepatectomy program. Methods: 204 donors who underwent donor hepatectomy between June 1996 to September 2019 were reviewed retrospectively and compared to outcomes in high volume centres. Results: At 6 months, overall donor morbidity rate was 20/204 (9.8%). Wound complications were most common at 5/204 (2.5%). Majority of complications were either Clavien grade 1 or 2 and only 3 donors had Clavien grade 3 complications. There was zero donor mortality. Discussion: Our centre's donor morbidity rate of 9.8% is the one of the lowest reported in the published literature. With increased experience, stringent donor selection and enhanced perioperative care by a multi-disciplinary team, outcomes in a medium volume centre can match the outcomes reported in high volume centres. The framework for quality in terms of structure, process and outcomes is presented which can be adopted for developing programs.
MeSH term(s)	Hepatectomy/adverse effects ; Humans ; Liver Transplantation/adverse effects ; Living Donors ; Postoperative Complications ; Retrospective Studies
Language	English
Publishing date	2021-09-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2021.08.946
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Article ; Online: Impact of donor age on recipient morbidity and mortality after living donor liver transplantation.

Yeow, Marcus / Pang, Ning Qi / Muthiah, Mark D / Soon, Gwyneth / Yock-Young, Dan / Bonney, Glenn Kunnath / Iyer, Shridhar Ganpathi / Madhavan, Krishnakumar / Kow, Wei Chieh Alfred

ANZ journal of surgery

2022 Volume 92, Issue 7-8, Page(s) 1867–1872

Abstract: Background: Evidence for use of graft from older donors in living donor liver transplantation (LDLT) has been conflicting. This study aims to clarify the impact of donor age on recipient morbidity and mortality after adult LDLT.: Methods: A total of ... ...

Abstract	Background: Evidence for use of graft from older donors in living donor liver transplantation (LDLT) has been conflicting. This study aims to clarify the impact of donor age on recipient morbidity and mortality after adult LDLT. Methods: A total of 90 live liver donors and recipients who underwent primary adult-to-adult LDLT were divided into three groups according to donor age: donors in 20s (D-20s) group, donors in 30s and 40s (D-30s and 40s) group and donors in 50s & 60s (D-50s and 60s) group. Multivariate analyses were conducted to look for independent risk/prognostic factors. Donor age was analysed as a continuous variable to determine an optimal cut off. Results: Overall donor morbidity was 4/90 (4.44%), major donor morbidity was 1/90 (1.11%) and there was no donor mortality. Recipients in the D-20s group had better 1-, 3- and 5-year recipient survival than recipients in the D-50s and 60s group (96%, 91%, 91% versus 73%, 58%, 58%, respectively) (P = 0.020). Donor age was identified to be an independently significant risk factor for increased major complications (P = 0.007) and prognostic factor for reduced overall survival (P = 0.014). The optimal donor age cut off was determined to be 46.5 years old. Conclusion: Older donors are associated with poorer recipient outcomes after adult-to-adult LDLT. Usage of liver grafts from older donors should be carefully considered when choosing liver grafts for patients undergoing LDLT.
MeSH term(s)	Adult ; Age Factors ; Graft Survival ; Humans ; Liver Transplantation ; Living Donors ; Middle Aged ; Morbidity ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-07-02
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.17877
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Article ; Online: Optimization of Outpatient Transplantation Services During the COVID-19 Pandemic: A South-East Asian Tertiary Organ Transplant Centre Experience.

Tan, Jarrod Kah Hwee / Pang, Ning Qi / Bonney, Glenn Kunath / Kow, Alfred Wei Chieh / Vathsala, Anantharaman / Iyer, Shridhar Ganpathi

The British journal of surgery

2020 Volume 107, Issue 11, Page(s) e506–e507

MeSH term(s)	Asia, Southeastern/epidemiology ; COVID-19/epidemiology ; Comorbidity ; Humans ; Organ Transplantation/methods ; Outpatients/statistics & numerical data ; Pandemics ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-08-21
Publishing country	England
Document type	Letter
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.11968
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Article: Multimodal prehabilitation before major abdominal surgery: A retrospective study.

Pang, Ning Qi / He, Stephanie Shengjie / Foo, Joel Qi Xuan / Koh, Natalie Hui Ying / Yuen, Tin Wei / Liew, Ming Na / Ramya, John Peter / Loy, Yijun / Bonney, Glenn Kunnath / Cheong, Wai Kit / Iyer, Shridhar Ganpathi / Tan, Ker Kan / Lim, Wan Chin / Kow, Alfred Wei Chieh

Annals of the Academy of Medicine, Singapore

2022 Volume 50, Issue 12, Page(s) 892–902

Abstract: Introduction: Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme.: Methods: Patients aged 65 years ... ...

Abstract	Introduction: Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme. Methods: Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation. Results: There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay ( Conclusion: The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.
MeSH term(s)	Humans ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Preoperative Care ; Preoperative Exercise ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2022-01-05
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
DOI	10.47102/annals-acadmedsg.2021264
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