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The rationale for this approach is that minute residual bile duct remnants may be present in the fibrous tissue of the porta hepatis and thus provide direct connection with the intrahepatic ductule system to allow bile drainage. [2] This procedure was developed in 1951 by Japanese biliary and hepatic pediatric surgeon Morio Kasai (1922–2008).
Access to the porta hepatis: The Kocher manoeuvre allows access to the porta hepatis, the gateway to the liver. By mobilizing the duodenum and pancreas, surgeons gain exposure to the structures in the hepatic portal area. Exposure of hepatoduodenal ligament: The procedure facilitates the dissection and exposure of the hepatoduodenal ligament.
Thus, in people with advanced liver disease the shunting of portal blood away from hepatocytes is usually well tolerated. However, in some cases suddenly shunting portal blood flow away from the liver may result in acute liver failure secondary to hepatic ischemia. [6] Acute hepatic dysfunction after TIPS may require emergent closure of the shunt.
Liver surgery is safe when performed by experienced surgeons with appropriate technological and institutional support. As with most major surgical procedures, there is a marked tendency towards optimal results at the hands of surgeons with high caseloads in selected centres (typically cancer centres and transplantation centres).
Morio Kasai (葛西 森夫; September 29, 1922 – December 8, 2008) was a Japanese surgeon who had a strong interest in pediatric surgery.While Kasai went into practice at a time when pediatric surgery was not an established subspecialty, much of his clinical and research work was related to the surgical care of children.
The porta hepatis or transverse fissure of the liver is a short but deep fissure, about 5 cm long, extending transversely beneath the left portion of the right lobe of the liver, nearer its posterior surface than its anterior border.
The Pringle manoeuvre is used during liver surgery and in some cases of severe liver trauma to minimize blood loss. [1] For short durations of use, it is very effective at reducing intraoperative blood loss. [2] The Pringle manoeuvre is applied during closure of a vena cava injury when an atriocaval shunt is placed. [citation needed]
Diet: A high-calorie diet is recommended. [17] Many people develop nausea and cannot tolerate food later in the day, so the bulk of intake may be concentrated in the earlier part of the day. [ 17 ] In the acute phase of the disease, intravenous feeding may be needed if patients cannot tolerate food and have poor oral intake subsequent to nausea ...