Artery Duct Research Articles

Proximity predicament: a rare case of hydatid cyst in the porta hepatis region

Hydatid cysts near the porta hepatis present notable medical challenges due to their intricate positioning and potential influence on crucial structures within the liver and its vicinity. While relatively rare, their presence can lead to intricate medical scenarios because of their proximity to vital liver and bile duct structures, but their occurrence can present complex medical situations due to their proximity to critical structures in the liver and bile ducts. We present an unusual case of a 33-year-old male with no known comorbidities presented to the outpatient department of general surgery with pain, insidious in onset and gradually progressive, in the right hypochondrial region for the past 3 months, along with mild fever, reduced appetite, and weight loss of 3 kg. Managing hepatic cysts, especially when near the porta hepatis, poses significant diagnostic challenges. Imaging scans revealed multiple hypodense lesions suggestive of hepatic cysts, with the largest one measuring 5 cm × 8 cm in segment VI. Native post-contrast lesions were also observed in the right lower lobe. Although hepatic duct dilation was not observed, the presence of a cyst near the porta hepatis an atypical site for hydatid cyst, complicated potential PAIR procedures (puncture, aspirate, injection, re-aspirate), raising concerns about the risk of damaging vital structures like the hepatic artery or major bile duct. A multidisciplinary approach engaged interventional radiology to evaluate PAIRS feasibility. PAIRS was performed successfully, except for the cyst near the porta hepatis to avoid complications. Despite this, the patient continued to experience abdominal discomfort post-operation, although liver function tests improved in the postop period. This case underscores the uncommon occurrence of hydatid cysts near the porta hepatis and highlights the need for additional research to comprehend its prevalence and causes. Further investigation is crucial to enhance our understanding of the epidemiology and optimal management strategies involving PAIRS in such challenging cases.

Morphological and Histological Description of Spiny Dogfishshark Liver, Squalusacanthais(Linnaeus,1758),Elasmobranchii,Squaliformes

The current study describes the morphological and histological appearance of the liver of the spiny dogfish Squalusacanthais, which is classified as Class: Chondrichthyes, Subclass: Elasmobranchi. Morphologically, the liver was observed as large, and consists of two symmetrical lobes connected from the upper side, and the gallbladder was observed in the right lobe. Histologically, liver sections were prepared with H&E stain, and examined with a light microscope. Hepatic parenchyma was surrounded by a capsule of connective tissue and primarily composed of hepatocytes. The nuclei of these cells were observed at the terminal site, with lipid droplets in the cytoplasm. Central veins were observed, surrounded by connective tissue and lined with a squamous epithelial layer. Hepatocytes were, separated by numerous blood sinusoids with connective tissue. Blood arteries were observed, surrounded by thick muscular fiber walls and narrow lumens compared to veins. The portal vein was observed, along with the artery and bile duct, surrounded by a thick connective tissue. The bile duct was surrounded by a layer of muscular fibers, lined with a simple columnar epithelial layer with clear nuclei, and a connective tissue layer. Melanin-containing cells were observed, but no hepatic lobules or connective tissue were seen between them. Additionally, Hepato-pancreatic tissue was not identified.

Surgical Approach to Necrotizing Fasciitis in the Buccal Fat Pad

Cervicofacial necrotizing fasciitis (CNF) of the face is a rare and potentially life-threatening bacterial infection that requires immediate intervention. CNF involving the buccal fat pad particularly demands surgical drainage, with attention to the surrounding anatomical structures to prevent vascular or nerve damage. In this study, we reviewed the anatomy of buccal fat pads to suggest appropriate surgical approaches. A retrospective chart review was conducted on seven patients with CNF who had a buccal fat pad abscess requiring surgical incision and drainage between January 2022 and August 2023. Abscesses within the central buccal fat pad and its pterygoid extensions were drained via intraoral incisions. Abscesses in the temporal extension were addressed by the Dingman approach. All patients underwent our surgical drainage regimen combined with proper intravenous antibiotics, leading to successful treatment of CNF without significant functional sequelae, with an average stay of 18.71 days. The buccal fat pad, which corresponds to the deep space of the face, is surrounded by vital structures such as the facial artery, vein, nerve, and parotid duct. When treating abscesses in the buccal fat pad, it is important to understand the relationship of the fat pad to other vital structures for optimal outcomes.

Evaluation of Variation in the Calot’s Triangle at a Tertiary Care Hospital in Northern Uttar Pradesh, India: A Cross-sectional Study

Introduction: Cholelithiasis is the most common disease worldwide, and laparoscopic cholecystectomy is the standard treatment of choice. To perform laparoscopic cholecystectomy, it is essential to understand the critical view of safety, which primarily involves the dissection of Calot's triangle. Anatomical variations in Calot's triangle exist, and understanding them is crucial to avoid unintended situations during surgery. Mirizzi syndrome, a rare complication in Calot's triangle, can significantly increase mortality and morbidity rates. Aim: To evaluate the anatomical variations in the Calot’s triangle. Materials and Methods: A cross-sectional study was conducted at Mayo Institute of Medical Sciences, Department of General Surgery, from October 2021 to September 2022. The total sample size included 100 patients with gallstone disease who underwent surgical intervention. Intraoperative findings, such as variations in the cystic artery and cystic duct, as well as Mirizzi syndrome grading, were recorded in an Excel sheet and tabulated. The results were expressed in terms of frequency and percentage. Results: The average age of the patients was 39.42±12.11 years, with females outnumbering males. Among them, 28% had a cystic artery lying outside of Calot's triangle, and 96% had a cystic artery originating from the right hepatic artery. The remaining 2% originated from an aberrant right hepatic artery, 1% from the left hepatic artery, and 1% from the gastroduodenal artery. Cystic duct variations were found in 5% of cases. Of these, 2% had a short cystic duct (<2 cm), 1% had a long cystic duct (approximately 5 cm), one patient had an absent cystic duct, and one had a low insertion into the common hepatic duct. Mirizzi syndrome Grade-I and Grade-II patients accounted for 4% and 2% respectively, while Grade-III, Grade-IV, and Grade-V each contributed to 1%. Conclusion: Knowledge of Calot's triangle variations is crucial, especially for aspiring surgeons, as it helps them make decisions promptly when encountering difficulties during surgery. Understanding the Calot's region ensures the safety not only of patients but also of surgeons.

Successful Laparoscopic Hepaticojejunostomy for Infant Congenital Biliary Dilatation with both Aberrant Right Hepatic Artery and Bile Duct from the Caudate Region.

A boy with congenital hydronephrosis underwent ultrasonography every month for follow-up. At 4 months of age, ultrasonography incidentally revealed congenital biliary dilatation (5-cm type Ia). We performed laparoscopic extrahepatic bile duct resection and hepaticojejunostomy. After dissecting the dilated common bile duct (CBD), we found that the arcading-like shaped right hepatic artery (RHA) coursed in front of the CBD. Additionally, a tiny duct was identified below the main hepatic duct. At first, we thought it was a lymphatic vessel and dissected it from the main hepatic duct. However, bile flow out was recognized after dissecting the tiny duct. Finally, we confirmed it as an aberrant bile duct from the caudate region. We anastomosed the bile duct from the caudate region and main hepatic duct in a double-barrel fashion and performed hepaticojejunostomy below the RHA. The postoperative course was uneventful. Ultrasonography showed no intrahepatic ductal dilatation including the caudate lobe.

Evaluation for the anatomical correctness of fusion image of three-dimensional hilar structure including portal vein, hepatic artery and bile duct

Evaluation for the anatomical correctness of fusion image of three-dimensional hilar structure including portal vein, hepatic artery and bile duct

Variations of the hepatic artery and bile duct in patients with pancreaticobiliary maljunction: Impact on postoperative outcomes.

Preoperative comprehension of the anatomical variations of the hepatic artery and bile duct is essential for safe laparoscopic surgery for pancreaticobiliary maljunction (PBM). This study aimed to investigate the impact of anatomical variations of the hepatic artery and bile duct on surgical technique and postoperative complications. We conducted a retrospective review of patients with PBM who underwent laparoscopic surgery at our institution between January 2014 and December 2022 to investigate anatomical variations in the hepatic artery and bile duct, surgical technique, and postoperative complications. We included 112 patients with PBM, with a median age of 4 years (interquartile range, 0-55). Overall, 29 of 112 patients had an aberrant right hepatic artery (ARHA) running ventral to the common hepatic duct (CHD), and they underwent hepaticojejunostomy on the ventral side of the ARHA. Additionally, eight of 112 patients had an aberrant posterior hepatic duct (APHD), which was joined to the CHD in all but one case. The presence of APHD was associated with postoperative bile leak occurrence. Performing hepaticojejunostomy ventral to the ARHA is important to prevent complications. Furthermore, APHD may be a risk factor for postoperative bile leak and requires careful bile duct plasty.

Do not get stumped: multimodality imaging findings of early and late post-cholecystectomy complications

Cholecystectomy is the most performed intra-abdominal surgical procedure in the US, with 1.2 million performed annually, and is predominantly performed laparoscopically. Although largely safe, laparoscopic cholecystectomy results in higher rates of abdominal symptoms consisting of abdominal pain and dyspepsia, which may persist or recur, collectively known as post-cholecystectomy syndrome. This article aims to (1) provide an overview of post-cholecystectomy syndrome with an emphasis on biliary complications and emergent imaging findings, (2) illustrate the spectrum of imaging findings of early and late post-cholecystectomy complications, (3) enumerate the role of various imaging modalities in evaluating post-cholecystectomy complications and address the role of selective trans-catheter coil embolization in managing bile leaks, and (4) discuss pearls and pitfalls in imaging following cholecystectomy. While common first-line imaging modalities for post-cholecystectomy complications include CT and sonography, ERCP and MRCP can delineate the biliary tree with greater detail. Scintigraphy has a higher sensitivity and specificity than CT or sonography for diagnosing bile leak and may preclude the need for ERCP. Post-operative complications include biliary duct injury or leak, biliary obstruction, remnant gallbladder/cystic duct stones and inflammation, biliary dyskinesia, papillary stenosis, and vascular injury. Subtle cases resulting in lethal outcomes, such as hemorrhage from the gallbladder bed without major vessel injury, have also been described. Cases presented will include biliary complications such as post-cholecystectomy stump cholecystitis, nonbiliary complications such as subcapsular hematoma, and normal post-surgical findings such as oxidized regenerated cellulose. Post-operative biliary complications can cause significant morbidity and mortality, and thus familiarity with the expected post-surgical appearance of the gallbladder fossa and biliary tract, as well as understanding the spectrum of complications and associated multimodality imaging findings, are essential for emergency radiologists and those practicing in the acute care setting to direct appropriate patient management. Furthermore, many of the postoperative complications can be managed by noninvasive percutaneous interventional procedures, from drain placement to cystic artery and cystic duct stump embolization.

The current landscape of pediatric living donor liver transplantation in the United States: Benefits, challenges, and future directions.

The current landscape of pediatric living donor liver transplantation in the United States: Benefits, challenges, and future directions.

Association of Early Bifurcation of Hepatic Artery With Arterial Injury in Right-Sided Living-Donor Hepatectomy: Retrospective Analysis of 500 Cases.

The aim of this study was to explore the incidence of early bifurcation of the right hepatic artery (RHA) and the right posterior hepatic artery (RPHA), which is crucial in right lobe graft (RLG) and right posterior sector graft (RPSG) procurement for living-donor liver transplantation. Early bifurcation of the hepatic artery tends to induce oversight of one of the bifurcated arteries and its injury in RLG/RPSG procurement. Unrecognizable on conventional 3-dimensional (3-D) images, its significance is underestimated. We enrolled 500 patients who underwent preoperative imaging for scheduled surgeries at two major transplant centers. All-in-one 3-D images consisting of the hepatic artery, portal vein, and bile duct were constructed. Early bifurcation of the RHA and the RPHA was defined as the arteries bifurcating proximal to the cutting line of the right hepatic duct and the right posterior duct, respectively. Early bifurcation of the RHA was seen in 11.3% of cases of an infra-portal RPHA and in 46.0% of cases of a supraportal RPHA ( P < 0.001). Early bifurcation of the RPHA was encountered in 35.3% of cases of an infra-portal RPHA, in no cases of a supra-portal RPHA, and in 100% of cases in which the arteries to segment 6/7 arose individually from the RHA. The overall incidence of early bifurcation was 19.9% for RHA and 43.6% for RPHA. Early bifurcation of the RHA and the RPHA is frequently encountered and requires caution for RLG/RPSG procurement. Special attention should be paid to supraportal RPHA for RLG procurement.

PS-C30-4: ASSOCIATION OF ASSISTED REPRODUCTIVE TECHNOLOGIES WITH ARTERIAL HYPERTENSION DURING NEWBORN

In Japan, infertility treatment including assisted reproductive technologies &lt; ART&gt; has become common recently, accounting for 7% of ART newborns in all births. Recently, ART has been reported to induce premature vascular aging in apparently healthy children. It is unknown whether the onset of premature vascular aging begins in the newborn period. Our study was to determine whether an increased risk of premature vascular aging is associated with ART. The study population comprised 63 newborns &lt; median gestational age&lt;GA&gt; 39 weeks, and median birth weight &lt;BW&gt; 3050g&gt;in the assisted conception &lt;AC&gt; group and 279 newborns &lt;GA 39 weeks, BW 3030g&gt; in the spontaneous conception &lt;SC&gt; group. The AC group was treated as follows: 29 patients with in vitro fertilization, or with intracytoplasmic sperm injection with ovulation-inducing agents &lt;ART group&gt;, 34 with artificial insemination, and others. After confirming the closing of the patent ductus artery using echocardiography, newborns measured their peripheral systolic &lt;sys&gt; and diastolic &lt;dia&gt; blood pressure &lt;BP&gt; values. BP measurements of newborns were performed in the left or right legs in the relaxed supine position with basically a natural sedation. At the median age of one day after birth, comparing sys and dia BP with AC and SC group, sys BP 69 and 40mmHg vs 68 and 41mmHg, there were no significant. Similarly, in the ART group, sys and dia BP was 68 and 40mmHg, with no significant differences. However, there were significant differences between maternal age, SC, AC, and ART groups, with the median of 31years, 35years, and 37years &lt;p value less than 0.001&gt;. We found no evidence of increased risk of premature vascular aging with ART for infertility treatment during the newborn period. Older maternity may alter affect childhood health and development. In addition, in vitro or extrauterine fertilization exposes gamete and embryo to variable physical and hormonal environments before implantation. Exposure is brief in fresh fertilizations and more prolonged in a gamete or embryo cryopreservation, and such epigenetic modifications of the environment may have downstream effects on the vascular system. The future of precision medicine guided approaches should incorporate emerging clinical factors, such as the history of ART conception in a growing proportion of the population.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Single‐cell spatial transcriptomics analysis of a regenerating liver

Liver, the largest gland in the body performs more than 500 functions. It is comprised of lobules, which are the functional metabolic units formed by a central vein in the center, and multiple portal triads at the periphery. Each portal triad is composed of a portal vein, hepatic artery and bile duct. Blood enters the lobule through portal vein and hepatic artery and moves through sinusoids that are lined by the sinusoidal endothelial cells (LSECs) and eventually exits through the central vein. Hepatocytes line the other side of the endothelial cells along the porto‐central axis. Intriguingly, the hepatocytes located across the lobule express genes differently based on their proximity to portal triad (zone‐1) versus central vein (zone‐3). This process of metabolic zonation ensures division of labor making hepatocytes more efficient in performing their endowed functions of synthesis, metabolism and detoxification based on their location in specific zones. Recent studies have begun to show that zonation of gene expression exists not only in hepatocytes but also in other minority cell types of the liver including cholangiocytes, endothelial cells, macrophages and stellate cells. Liver is also a unique organ with an innate capability to regenerate following toxicant‐induced injury or surgical resection. The process of regeneration is ensured by replication of all surviving cells in the liver. Very little is known about how metabolic zonation changes during the process of regeneration and how the various functions performed by the liver are maintained while the hepatocytes and other cells undergo replication towards attaining the pre‐hepatectomy mass. Here, we perform Molecular CartographyTM, a single cell spatial transcriptomics technique, to address changes in the both the expression and location of both zonated and non‐zonated genes in various cell types of the liver following partial hepatectomy. We address how these one hundred carefully selected genes undergo dynamic regulation as cells in the remnant liver attempt to maintain both function and proliferate to restore liver mass. In our current study we identify dynamic changes in spatiotemporal regulation of multiple important genes associated with most proliferation and function of cells during the process of liver regeneration.

Comparative study on a novel lobule structure of the zebrafish liver and that of the mammalian liver.

The mammalian liver has a lobule structure with a portal triad consisting of the portal vein, hepatic artery, and bile duct, which exhibits zonal gene expression, whereas those of teleosts do not have a portal triad. It remains to be demonstrated what kind of the unit structures they have, including their gene expression patterns. The aims of the present study were to demonstrate the unit structure of the teleost liver and discuss it in terms of evolution and adaptation in vertebrates and the use of teleosts as an alternative model for human disease. The zebrafish liver was examined as a representative of teleosts with respect to its morphological architecture and gene expression. A novel, polygonal lobule structure was detected in the zebrafish liver. In it, portal veins and central veins were distributed at the periphery and center, respectively. Sinusoids connected both veins. Anxa4-positive preductules were incorporated into the tubular lumen of two rows of hepatocytes in sections. Intrahepatic bile ducts resided randomly in the liver lobule. Zebrafish livers did not have zonal gene expression for metabolic pathways examined. The lobules of the zebrafish liver with preductules located in the tubular lumina of hepatocytes may resemble the oval cell reaction of injured livers of mammals and might convey bile to the intestine more safely than mammalian livers. The gene expression pattern in liver lobules and our liver lobule model of the zebrafish may be important to discuss data obtained in experiments using this animal as an alternative model for human disease.

Development of the nervous system in mouse liver

BACKGROUNDThe role of the hepatic nervous system in liver development remains unclear. We previously created functional human micro-hepatic tissue in mice by co-culturing human hepatic endodermal cells with endothelial and mesenchymal cells. However, they lacked Glisson’s sheath [the portal tract (PT)]. The PT consists of branches of the hepatic artery (HA), portal vein, and intrahepatic bile duct (IHBD), collectively called the portal triad, together with autonomic nerves.AIMTo evaluate the development of the mouse hepatic nervous network in the PT using immunohistochemistry.METHODSLiver samples from C57BL/6J mice were harvested at different developmental time periods, from embryonic day (E) 10.5 to postnatal day (P) 56. Thin sections of the surface cut through the hepatic hilus were examined using protein gene product 9.5 (PGP9.5) and cytokeratin 19 (CK19) antibodies, markers of nerve fibers (NFs), and biliary epithelial cells (BECs), respectively. The numbers of NFs and IHBDs were separately counted in a PT around the hepatic hilus (center) and the peripheral area (periphery) of the liver, comparing the average values between the center and the periphery at each developmental stage. NF-IHBD and NF-HA contacts in a PT were counted, and their relationship was quantified. SRY-related high mobility group-box gene 9 (SOX9), another BEC marker; hepatocyte nuclear factor 4α (HNF4α), a marker of hepatocytes; and Jagged-1, a Notch ligand, were also immunostained to observe the PT development.RESULTSHNF4α was expressed in the nucleus, and Jagged-1 was diffusely positive in the primitive liver at E10.5; however, the PGP9.5 and CK19 were negative in the fetal liver. SOX9-positive cells were scattered in the periportal area in the liver at E12.5. The Jagged-1 was mainly expressed in the periportal tissue, and the number of SOX9-positive cells increased at E16.5. SOX9-positive cells constructed the ductal plate and primitive IHBDs mainly at the center, and SOX-9-positive IHBDs partly acquired CK19 positivity at the same period. PGP9.5-positive bodies were first found at E16.5 and HAs were first found at P0 in the periportal tissue of the center. Therefore, primitive PT structures were first constructed at P0 in the center. Along with remodeling of the periportal tissue, the number of CK19-positive IHBDs and PGP9.5-positive NFs gradually increased, and PTs were also formed in the periphery until P5. The numbers of NFs and IHBDs were significantly higher in the center than in the periphery from E16.5 to P5. The numbers of NFs and IHBDs reached the adult level at P28, with decreased differences between the center and periphery. NFs associated more frequently with HAs than IHBDs in PTs at the early phase after birth, after which the number of NF-IHBD contacts gradually increased.CONCLUSIONMouse hepatic NFs first emerge at the center just before birth and extend toward the periphery. The interaction between NFs and IHBDs or HAs plays important roles in the morphogenesis of PT structure.

Anatomical and radiographic distribution of hepatic artery and biliary duct system applied to biochemical parameters indicative to hepatobiliary disease in Egyptian donkey (Equus asinus)

AbstractThe current study was performed on ten adult Egyptian donkeys of both sexes for anatomical and radiographic studies in addition to six other donkeys for enzymatic, biochemical and statistical analysis. The aim was to illustrate the normal hepatic arterial and biliary distribution using different anatomic techniques and radiographic imaging besides, establishing an accurate laboratory profile specific for donkeys that used as standard indicators for hepatobiliary dysfunction. The right branch of the hepatic artery in donkey forms a curved arch erupting five branches, unlike the left branch that erupts six branches, being the direct continuation of the main hepatic artery. The caudate lobe artery either originated from the hepatic artery or its right division. The common hepatic duct represented a very clear enlargement called ‘gall tank’ at its terminal pouring intestinal end and compensating absence of gall bladder, cystic and common bile ducts. The intrahepatic biliary distribution is characterized by a segmental ramification into dorsal, intermediate, and ventral branches of bile ductules especially noticed in the undivided right lobe and left lateral lobe. The quadrate lobe is divided according to its biliary drainage into right and left parts where the former is drained by the left hepatic duct while the latter is drained through a branch from R. lobi medialis sinistri. The serum enzymatic activity was slightly similar to that of the horse while some biochemical parameters differentiating the donkey from the horse such as lowered total bilirubin, serum bile acids, and higher triglycerides, blood urea and prolonged prothrombin time.

Nadir Görülen Sol Lob Yerleşimli Safra Kesesi Operasyonu: Olgu Sunumu

Situs viscerium inversus gall bladder located in left lobe of the liver (LSG- woSVI) is a rare congenital anomaly. This condition is mostly detected during surgery and therefore causes technical difficulties. Our case is 55 year old female patient with complaints of indigestion and bloating. In the ultrasound (USG) image, there were multıple Stones, the largest of which was 1 cm in diamater. However, left lobe localization could not be detected on imaging. On laparoscopy, it was observed that the falciform ligament was adhered to the left side under segment III. Our patient did not have total situs inversus. In oerder to avoid complications, unlike classical cholecystectomy, artery and duct clipping is an important detail after dissection of the gall bladder from the antegrade liver bed before clipping the cystic artery and cystic duct. In this case, we successfully performed laparoscopic antegrade cholecystectomy. We discharged the patient on post op day one without any problem. Keywords: Left gallbladder, laparoscopic cholecystectomy, case report, sinistrolation, ectopic gallbladder

Anterior Glissoneon approach: A novel technique for liver resections and our experience

Glisson’s sheath was discovered by Johannis Walaeus in 1640. Francis Glisson published his book entitled Anatomia Hepatis in 1654 and accurately portrayed the essential anatomy of the major vessels of the liver, The Glisson’s capsule wraps the portal vein, hepatic artery and bile duct and these three structures are therefore regarded as forming one morphological system, which since then has been referred to as the Glissonean system.

Hem-o-lok clips are safe and efficacious for laparoscopic cholecystectomy: Preliminary results of a single center experience

Introduction: The aim of this retrospective study was to compare the outcomes after laparoscopic cholecystectomy using titanium clips or Hem-o-lok polymeric clips to close cystic artery and cystic duct. Methods: A total of 154 patients who underwent laparoscopic cholecystectomy for gallbladder disease from January 2019 to December 2019 at the Department of Surgery of the San Giovanni Addolorata Hospital in Rome (Italy) were studied retrospectively. In 100 patients, titanium clips were used, while Hem-o-lok clips were used in 54 patients. In the two groups, patients' demographic characteristics, laboratory tests and postoperative complications were analyzed. Results: The mean length of hospital stay was shorter in the Hem-o-lok group compared to the titanium clips group (2.0 SD0.7 vs. 3.6 SD5.5, p &lt; 0.05). The overall complication rates for the titanium clips and the Hem-o-lock clips groups were 9% and 0% 7 days after surgery (p &lt; 0.05), 10% and 9.3% 30 days after surgery, 13% and 16.7% 180 days after surgery. There were no statistically significant differences between the two groups in the typology of complications. Conclusion: Based on our results, Hem-o-lock have better postoperative outcomes after laparoscopic cholecystectomy for gallbladder disease in terms of complication rate 7 days after surgery and in terms of mean length of hospital stay. Keywords: laparoscopic cholecystectomy; Hem-O-Lok polymeric clips; titanium clips; biliary leakage; retrospective study.

A novel, simplified, and reproducible porcine model of acute ischemic liver failure with portal vein preservation.

The current ischemic models of liver failure are difficult and usually time-consuming to produce. The aim of this study was to develop a simplified and reproducible porcine model of acute liver failure for use in preclinical research. Eighteen Bama miniature pigs were randomly divided into Groups A, B, and C. The hepatic artery and common bile duct were ligated in all groups. While the portal vein was completely preserved in Group A, it was narrowed by 1/3 and 1/2 in Groups B and C, respectively. Results of biochemical analyses, encephalopathy scores, and survival times were compared among the groups. Results of hematoxylin-eosin staining, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling, Masson staining, and Ki-67 analyses were recorded. Survival times in Groups B and C were 11.67 ± 1.86 and 2.16 ± 0.75 days, respectively, shorter than that in Group A (>15 days). Following surgery, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, total bilirubin, and direct bilirubin levels significantly increased relative to baseline values in all groups (P<0.05). Groups B and C exhibited a significant decrease in encephalopathy scores and a significant increase in ammonia levels, which were negatively correlated with one another. Pathological analysis revealed obvious necrosis of liver cells, which correlated closely with the degree of portal vein constriction. Our simple, highly reproducible model effectively mimics the clinical characteristics of acute liver failure in humans and provides a foundation for further research on artificial liver support system development.