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Article ; Online: Implementation of an ERAS protocol on cirrhotic patients in liver resection: a cohort study.

Reyes, María Pérez / Pérez, Belinda Sánchez / González, Claudia Sánchez / Daga, José Antonio Pérez / Villalba, Julio Santoyo / Santoyo, Julio Santoyo

Updates in surgery

2024

Abstract: The development of laparoscopic liver surgery, the improvement in the perioperative care programs, and the surgical innovation have allowed liver resections on selected cirrhotic patients. However, the great majority of ERAS studies for liver surgery ... ...

Abstract	The development of laparoscopic liver surgery, the improvement in the perioperative care programs, and the surgical innovation have allowed liver resections on selected cirrhotic patients. However, the great majority of ERAS studies for liver surgery have been conducted on patients with normal liver parenchyma, while its application on cirrhotic patients is limited. The purpose of this study was to evaluate the implementation of an ERAS protocol in cirrhotic patients who underwent liver surgery. We present an analytical observational prospective cohort study, which included all adult patients who underwent a liver resection between December 2017 and December 2019 with an ERAS program. We compare the outcomes in patients cirrhotic (CG)/non-cirrhotic (NCG). A total of 101 patients were included. Thirty of these (29.7%) were patients ≥ 70 cirrhotic. 87% of the both groups had performed > 70% of the ERAS. Oral diet tolerance and mobilization on the first postoperative day were similar in both groups. The hospital stay was similar in both groups (2.9 days/2.99 days). Morbidity and mortality were similar; Clavien I-II (CG: 44% vs NCG: 30%) and Clavien ≥ III (CG: 3% vs NCG: 8%). Hospital re-entry was higher in the NCG. Overall mortality of the study was 1%. ERAS protocol compliance was associated with a decrease in complications (ERAS < 70%: 80% vs ERAS > 90%: 20%; p: 0.02) and decrease in severity of complications in both study groups. The application of the ERAS program in cirrhotic patients who undergo liver surgery is feasible, safe, and reproducible. It allows postoperative complications, mortality, hospital stay, and readmission rates comparable to those in standard patients.
Language	English
Publishing date	2024-03-17
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-024-01769-8
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Article ; Online: Treatment of acute intraoperative Budd-Chiari syndrome by placement of silicone prosthesis.

Mirón Fernández, Irene / Sánchez Pérez, Belinda / Pérez Daga, José Antonio / Santoyo Santoyo, Julio

Cirugia espanola

2022 Volume 100, Issue 7, Page(s) 437–439

Abstract: Complete liver mobilization for major resections sometimes causes liver tilting due to the release of the suspensory elements of the liver. Rarely this may take to a liver abnormal position with acute obstruction to venous flow at the suprahepatic level ( ...

Abstract	Complete liver mobilization for major resections sometimes causes liver tilting due to the release of the suspensory elements of the liver. Rarely this may take to a liver abnormal position with acute obstruction to venous flow at the suprahepatic level (Budd-Chiari syndrome). To avoid this complication, techniques such as post-operative stent implantation have been described. The case of a patient who underwent a complete mobilization of the liver for resection of the inferior venous cava and a right renal tumor, was reported. After that, an acute Budd-Chiari Syndrome was observed caused of the liver malposition, which was solved with the placement of two silicone prostheses in the liver cell.
MeSH term(s)	Artificial Limbs/adverse effects ; Budd-Chiari Syndrome/etiology ; Budd-Chiari Syndrome/surgery ; Humans ; Silicones ; Vena Cava, Inferior/surgery
Chemical Substances	Silicones
Language	English
Publishing date	2022-05-10
Publishing country	Spain
Document type	Case Reports ; Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.cireng.2021.08.004
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Article ; Online: Impact of HCV Treatment on Recurrence of Hepatocarcinoma After Liver Transplantation.

Burgos, María Martinez / Grande, Rocío Gonzalez / Ortega, Susana López / Leiva, Inmaculada Santaella / Lombardo, Jesús De La Cruz / Santoyo, Julio Santoyo / Perez, Miguel Jimenez

Transplantation proceedings

2023 Volume 55, Issue 1, Page(s) 197–198

Abstract: The treatment of hepatitis C virus (HCV) has been a revolution in hepatology. Since the beginning of transplantation, liver cirrhosis and hepatocarcinoma on HCV cirrhosis has been the main etiology of liver transplantation. We set out to analyze the ... ...

Abstract	The treatment of hepatitis C virus (HCV) has been a revolution in hepatology. Since the beginning of transplantation, liver cirrhosis and hepatocarcinoma on HCV cirrhosis has been the main etiology of liver transplantation. We set out to analyze the impact that C virus treatment has had on liver transplantation. To do so, we divided our cohort into 2 periods, one before virus treatment (from 2000-2014) and one after the onset of treatment (2014-2020). Taking into account this differentiation, we analyzed the percentage of patients transplanted for hepatocarcinoma over cirrhotic liver by HCV in both groups. Among the patients transplanted for HCV, we analyzed whether there were differences in hepatocarcinoma recurrences according to their serologic status at the time of transplantation.
MeSH term(s)	Humans ; Liver Transplantation/adverse effects ; Hepacivirus ; Neoplasm Recurrence, Local ; Hepatitis C/etiology ; Carcinoma, Hepatocellular/complications ; Liver Cirrhosis/complications ; Liver Neoplasms/complications ; Recurrence
Language	English
Publishing date	2023-01-25
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.2022.12.011
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Article ; Online: Liver Transplant With Double Portal Anastomose: A Case Report.

Sánchez, Ana Isabel Fernández / Reyes, María Pérez / Pérez, Belinda Sánchez / Villalba, Julio Santoyo / Narváez, Jose Manuel Aranda / Santoyo, Julio Santoyo

Transplantation proceedings

2023 Volume 55, Issue 10, Page(s) 2304–2306

Abstract: Background: Reno-portal reconstruction is a surgical alternative to achieve enough portal flow in liver transplant when there is a complete portal thrombosis, provided there are collaterals or portosystemic shunt, with or without spleno-renal shunt.: ... ...

Abstract	Background: Reno-portal reconstruction is a surgical alternative to achieve enough portal flow in liver transplant when there is a complete portal thrombosis, provided there are collaterals or portosystemic shunt, with or without spleno-renal shunt. Methods: We present the case of a 58-year-old man with enolic cirrhosis and a history of gastrointestinal hemorrhage due to esophageal varices and portal thrombosis. The clinical case was discussed in the Transplant Committee, and the patient was included in the surgical waiting list with a Model for End-Stage Liver Disease score of 17 and Child-Pugh score of A6. The preoperative computer tomography scan showed significant collateral circulation with esophageal varices, varices dependent on the inferior mesenteric vein (IMV) and hypoplasic portal vein. During the operation, a large shunt from the IMV to the iliac territory and type II portal thrombosis were observed, which was managed with eversion thrombectomy. A temporary portocaval shunt was performed, showing minimal flow in the portal vein, which did not improve after ligation of the systemic shunt. It was decided to perform a reno-portal anastomosis, after which the portal flow measurement was 600 cc per minute; because of this, it was decided to supplement portal flow with an end-to-side portoportal anastomosis, obtaining a flow of 1300 cc per minute with low resistance (R0.5). Results: The postoperative period was favorable, with good evolution of liver analytical parameters, with permeability of the porto-portal venous anastomoses, reno-portal, arterial, and suprahepatic anastomoses in the imaging tests. Conclusion: If the portal flow is insufficient with a hypoplasic portal vein, a double anastomosis, portoportal, and reno-portal would be a technical resource.
MeSH term(s)	Male ; Humans ; Middle Aged ; Liver Transplantation/methods ; Esophageal and Gastric Varices ; End Stage Liver Disease ; Severity of Illness Index ; Portal Vein/diagnostic imaging ; Portal Vein/surgery ; Liver Diseases ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/etiology ; Venous Thrombosis/surgery
Language	English
Publishing date	2023-10-11
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2023.08.029
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Zs.A 835: Show issues

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Article ; Online: Recipient With Influenza A Infection: Contraindication to Transplant? A Case Report.

Sanchez-Gonzalez, Claudia / Pérez, Belinda Sánchez / Reyes, María Pérez / Aguilar, José Luis Fernández / Villalba, Julio Santoyo / Santoyo, Julio Santoyo

Transplantation proceedings

2023 Volume 55, Issue 10, Page(s) 2299–2300

Abstract: Active infections in recipients are considered an absolute contraindication to liver transplantation due to the risk of severe disease caused by the required immunosuppression. Even though viral infections, such as Influenza A, have been treated in liver ...

Abstract	Active infections in recipients are considered an absolute contraindication to liver transplantation due to the risk of severe disease caused by the required immunosuppression. Even though viral infections, such as Influenza A, have been treated in liver transplant patients both in the immediate and late postoperative period with favorable outcomes, no cases of prediagnosed Influenza A have been described in which the decision to proceed with the indication had to be made. In certain viral infections, like Influenza A, the paucisymptomatic state and the availability of appropriate treatment could open the door to performing liver transplants with positive results.
MeSH term(s)	Humans ; Influenza, Human/complications ; Transplants ; Liver Transplantation/adverse effects ; Immunosuppression Therapy/adverse effects ; Contraindications
Language	English
Publishing date	2023-10-10
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2023.08.026
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Article: New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report.

Sánchez Pérez, Belinda / Pérez Reyes, María / Aranda Narvaez, Jose / Santoyo Villalba, Julio / Perez Daga, Jose Antonio / Sanchez-Gonzalez, Claudia / Santoyo-Santoyo, Julio

World journal of transplantation

2024 Volume 14, Issue 1, Page(s) 89223

Abstract: Background: Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome (HPS) after liver transplant (LT), this case adds information and experience on this issue along with a treatment with positive outcomes. HPS is a ...

Abstract	Background: Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome (HPS) after liver transplant (LT), this case adds information and experience on this issue along with a treatment with positive outcomes. HPS is a complication of end-stage liver disease, with a 10%-30% incidence in cirrhotic patients. LT can reverse the physiopathology of this process and restore normal oxygenation. However, in some cases, refractory hypoxemia persists, and extracorporeal membrane oxygenation (ECMO) can be used as a rescue therapy with good results. Case summary: A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for HPS. He had good liver function (Model for End-Stage Liver Disease score 12, Child-Pugh class B7). He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%. The macroaggregated albumin test result was > 30. Spirometry demon strated a forced expiratory volume in one second (FEV1) of 78%, forced vital capacity (FVC) of 74%, FEV1/FVC ratio of 81%, diffusion capacity for carbon monoxide of 42%, and carbon monoxide transfer coefficient of 57%. He required domiciliary oxygen at 2 L/min (16 h/d). The patient was admitted to the intensive care unit (ICU) and extubated in the first 24 h, needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards. Reintubation was needed after 72 h. Due to the non-response to supportive therapies, installation of ECMO was decided with progressive recovery after 9 d. Extubation was possible on the tenth day, maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 h. He was discharged from ICU on postoperative day (POD) 20 with a 90%-92% oxygen saturation. Steroid recycling was needed twice for acute rejection. The patient was discharged from hospital on POD 27 with no symptoms, with an 89%-90% oxygen saturation. Conclusion: Due to the favorable results observed, ECMO could become the central axis of treatment of HPS and refractory hypoxemia after LT.
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Case Reports
ISSN	2220-3230
ISSN	2220-3230
DOI	10.5500/wjt.v14.i1.89223
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Article: Immediate post-operative complications (I): Post-operative bleeding; vascular origin: Thrombosis pancreatitis.

Perez Daga, Jose Antonio / Perez Rodriguez, Rosa / Santoyo, Julio

World journal of transplantation

2020 Volume 10, Issue 12, Page(s) 415–421

Abstract: Simultaneous pancreas-kidney transplantation is the treatment of choice for insulin-dependent diabetes that associates end-stage diabetic nephropathy, since it achieves not only a clear improvement in the quality of life, but also provides a long-term ... ...

Abstract	Simultaneous pancreas-kidney transplantation is the treatment of choice for insulin-dependent diabetes that associates end-stage diabetic nephropathy, since it achieves not only a clear improvement in the quality of life, but also provides a long-term survival advantage over isolated kidney transplant. However, pancreas transplantation still has the highest rate of surgical complications among organ transplants. More than 70% of early graft losses are attributed to technical failures, that is, to a non-immunological cause. The so-called technical failures include graft thrombosis, bleeding, infection, pancreatitis, anastomotic leak and pancreatic fistula. Pancreatic graft thrombosis leads these technical complications as the most frequent cause of early graft loss. Currently most recipients receive postoperative anticoagulation with the aim of reducing the rate of thrombosis. Hemoperitoneum in the early postoperative period is a frequent cause of relaparotomy, but it is not usually associated with graft loss. The incidence of hemoperitoneum is clearly related to the use of anticoagulation in the postoperative period. Post-transplant pancreatitis is another cause of early postoperative complications, less frequent than the previous. In this review, we analyze the most common surgical complications that determine pancreatic graft losses.
Language	English
Publishing date	2020-12-26
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2220-3230
ISSN	2220-3230
DOI	10.5500/wjt.v10.i12.415
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Article ; Online: Implementation of an ERAS protocol on elderly patients in liver resection.

Pérez Reyes, María / Sánchez Pérez, Belinda / León Díaz, Francisco Javier / Pérez Daga, José Antonio / Mirón Fernández, Irene / Santoyo Santoyo, Julio

Cirugia espanola

2022 Volume 101, Issue 4, Page(s) 274–282

Abstract: Background: The increase of quality of life, the improvement in the perioperative care programs, the use of the frailty index, and the surgical innovation has allowed to access of complex abdominal surgery for elderly patients like liver resection. ... ...

Abstract	Background: The increase of quality of life, the improvement in the perioperative care programs, the use of the frailty index, and the surgical innovation has allowed to access of complex abdominal surgery for elderly patients like liver resection. Despite of this, in patients aged 70 or older there is a limitation for the implementation ERAS protocolos. The aim of this study is to evaluate the implementation ERAS protocol on elderly patients (≥70 years) undergoing liver resection. Methods: A prospective cohort study of patients who underwent liver resection from December 2017 to December 2019 with an ERAS program. We compare the outcomes in patients ≥70 years (G ≥ 70) versus <70 years (G < 70). The frailty was measured with the Physical Frailty Phenotype score. Results: A total of 101 patients were included. 32 of these (31.6%) were patients ≥70 years. 90% of the both groups had performed >70% of the ERAS. Oral diet tolerance and mobilization on the first postoperative day were quicker in <70 years group. The hospital stay was similar in both groups (3.07days/2.7days). Morbidity and mortality were similar; Clavien I-II(G ≥ 70:41% vs G < 70:30,5%) and Clavien ≥ III (G ≥ 70:6% vs G < 70:8.5%), like hospital readmissions. Mortality was <1%. ERAS protocol compliance was associated with a decrease in complications (ERAS < 70%:80% vs ERAS > 90%:20%; p = 0.02) and decrease in severity of complications in both study groups. Frailty was found in 6% of the elderly group; the only patient who died had a frailty index of 4. Conclusion: Implementation of ERAS protocol for elderly patients is possible, with major improvements in perioperative outcomes, without an increase in morbidity, mortality neither readmissions.
MeSH term(s)	Humans ; Aged ; Prospective Studies ; Frailty ; Quality of Life ; Perioperative Care/methods ; Liver
Language	English
Publishing date	2022-07-30
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.cireng.2022.07.019
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Article ; Online: Laparoscopic anterior resection after failure of non-operative management in acute diverticulitis-a video vignette.

Reyes, María Pérez / García, Alberto Titos / Narváez, José Manuel Aranda / López, Laura Romacho / Sánchez, Antonio Jesús González / Santoyo, Julio Santoyo

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2022 Volume 25, Issue 3, Page(s) 519

MeSH term(s)	Humans ; Diverticulitis/surgery ; Diverticulitis, Colonic/surgery ; Laparoscopy ; Treatment Outcome
Language	English
Publishing date	2022-10-17
Publishing country	England
Document type	Video-Audio Media ; Letter
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16358
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Zs.A 5799: Show issues

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Article ; Online: Non-operative management to gallstone ileus.

Pérez Reyes, María / Mirón Fernández, Irene / Pitarch Martínez, María / Santoyo Santoyo, Julio

Cirugia espanola

2020 Volume 98, Issue 9, Page(s) 556

Title translation	Manejo conservador en íleo biliar.
Language	Spanish
Publishing date	2020-02-14
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.ciresp.2020.01.007
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