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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).
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.
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.
The hepatoduodenal ligament is the portion of the lesser omentum extending between the porta hepatis of the liver and the superior part of the duodenum. [citation needed] Running inside it are the following structures collectively known as the portal triad: [1] hepatic artery proper; portal vein; common bile duct
Ultrasonography (US) is the first-line imaging technique for the diagnosis and follow-up of portal hypertension because it is non-invasive, low-cost and can be performed on-site. [ 17 ] A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [ 18 ]
Hospitals are now required to tell you how much they charge for services.
For scale, cutting administrative costs to peer country levels would represent roughly one-third to half the gap. A 2009 study from Price Waterhouse Coopers estimated $210 billion in savings from unnecessary billing and administrative costs, a figure that would be considerably higher in 2015 dollars. [50] Cost variation across hospital regions.
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).