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| 1 | Ruptured hepatocellular carcinoma following chemoembolization:a western experience显示文摘BACKGROUND: Transcatheter arterial chemoembolization (TACE) is a recommended first line therapy for unresectable hepatocellular carcinoma (HCC). Serious complications such as neutropenic sepsis and hepatic decompensation are well known, but rupture of HCC following TACE is a rare and potentially fatal complication. The aim of this study was to identify the incidence of ruptured HCC following TACE and the associated risk factors. METHODS: A retrospective analysis was performed using our liver database with 'chemoembolization', 'ruptured HCC' covering the patients who received chemoembolization from January 1995 to December 2005. There were no exclusions. RESULTS: A total of 294 patients received chemoemboliza- tion in 530 sessions during the 10-year period. Of these, 2 ruptured following treatment (incidence 0.68%). The mean age was 65 years and the interval between the treatment and rupture was 2 and 24 days. The common factors were male sex, large tumor size (range 11-13 cm), and exophytic tumor growth. One patient died 2 days after rupture with hepatic decompensation while the second is alive after a 6-month follow up without tumor recurrence. CONCLUSIONS: Ruptured HCC following TACE is a rare but serious complication. Large tumor size, male sex, and exophytic growth of tumor may be predisposing factors for rupture. | Narendra Battula Parthi Srinivasan Mansoor Madanur Srinivas Prabhu Chava Oliver Priest Mohamed Rela Nigel Heaton | 2007 | Hepatobiliary & Pancreatic Diseases International2007，6，1： | 17 |
| 2 | Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis显示文摘BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June 2007.True visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of pancreatitis.Alcohol was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one each.All 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 each.One patient developed spontaneous thrombosis of the pseudoaneurysm.Fourteen patients had effective coil embolization of the pseudoaneurysm.One patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis radiologically.There were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their size.Co-existent portal hypertension and sepsis increase the risk of surgery.Angiography and selective coil embolization is a safe and effective way to arrest the hemorrhage. | Harsheet Sethi Praveen Peddu Andreas Prachalias Pauline Kane John Karani Mohamed Rela Nigel Heaton | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，6： | 12 |
| 3 | Pseudoaneurysm following laparoscopic cholecystectomy显示文摘BACKGROUND:Laparoscopic cholecystectomy(LC)is the operation of choice for removal of the gallbladder. Unrecognized bile duct injuries present with biliary peritonitis and systemic sepsis.Bile has been shown to cause damage to the vascular wall and therefore delay the healing of injured arteries leading to pseudoaneurysm formation.Failure to deal with bile leak and secondary infection may result in pseudoaneurysm formation. This study was to report the incidence and outcomes of pseudoaneurysm in patients with bile leak following LC referred to our hospital. METHODS:A retrospective analysis of our prospectively maintained liver database using pseudoaneurysm, bile leak and bile duct injury following laparoscopic cholecystectomy from January 2000 to December 2005 was performed. RESULTS:A total of 86 cases were referred with bile duct injury and bile leak following LC and of these,4 patients (4.5%)developed hepatic artery pseudoaneurysm(HAP) presenting with haemobilia in 3 and massive intra- abdominal bleed in 1.Selective visceral angiography confirmed pseudoaneurysm of the right hepatic artery in 2 cases,cystic artery stump in one and an intact but ectatic hepatic artery with surgical clips closely applied to the right hepatic artery at the origin of the cystic artery in the fourth case.Effective hemostasis was achieved in 3 patients with coil embolization and the fourth patient required emergency laparotomy for severe bleeding and hemodynamic instability due to a ruptured right hepatic artery.Of the 3 patients treated with coil embolization, 2 developed late strictures of the common hepatic duct. . (CHD)requiring hepatico-jejunostomy and one developed a stricture of left hepatic duct.All the 4 patients are alive at a median follow up of 17 months(range 1 to 65)with normal liver function tests. CONCLUSIONS:HAP is a rare and potentially life- threatening complication of LC.Biloma and subsequent infection are reported to be associated with pseudoaneurysm formation.Late duct stricture is common either due to unrecognized injury at LC or secondary to ischemia after embolization. | Mansoor Ahmed Madanur Narendra Battula Harsheet Sethi Rahul Deshpande Nigel Heaton Mohamed Rela | 2007 | Hepatobiliary & Pancreatic Diseases International2007，6，3： | 8 |
| 4 | Cancer of the uncinate process of the pancreas:surgical anatomy and clinicopathological features显示文摘BACKGROUND:The clinicopathological features of uncinate process pancreatic cancer(UPPC) are poorly described.Furthermore the anatomy of the uncinate process and its division during surgery are central to pancreaticoduodenectomy for UPPC.We set out to describe the embryology and anatomy of the uncinate process and the clinicopathological features of UPPC.DATA SOURCES:All published case series of UPPC were reviewed and included in this review.RESULTS:The true incidence of UPPC is difficult to quantify,with the reported incidence ranging from 2.5% to 10.7% of pancreatic cancer.There are 5 published series of UPPC including 117 patients,72 males and 45 females,aged from 45-53 years to 61-84 years.The median survival was 5 or 5.5 months in 3 of the series,12.1 months in another based only on potentially resectable lesions and 17 months in another based only on resected cases.CONCLUSIONS:The number of reported series of UPPC is limited,with vague symptoms as the predominant presenting features of the disease.The prognosis is poor with synchronous venous resection demonstrating a survival advantage. | Adrian W. O'Sullivan Nigel Heaton Mohamed Rela | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，6： | 6 |
| 5 | Laparoscopic liver resection:Wedge resections to living donor hepatectomy, are we heading in the right direction?显示文摘Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection(OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have dividedthis review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection(LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy(LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service. | P Thomas Cherian Ashish Kumar Mishra Palaniappen Kumar Vijayant Kumar Sachan Anand Bharathan Gadiyaram Srikanth Baiju Senadhipan Mohamad S Rela | 2014 | World Journal of Gastroenterology2014，20，37： | 4 |
| 6 | Pathological,molecular,and clinical characteristics of cholangiocarcinoma:A comprehensive review显示文摘Cholangiocarcinomas are a heterogeneous group of highly aggressive cancers that may arise anywhere within the biliary tree.There is a wide geographical variation with regards to its incidence,and risk-factor associations which may include liver fluke infection,primary sclerosing cholangitis,and hepatolithiasis amongst others.These tumours are classified into intrahepatic,perihilar and distal based on their anatomical location.Morphologically,intrahepatic cholangiocarcinomas are further sub-classified into small and large duct variants.Perihilar and distal cholangiocarcinomas are usually mucin-producing tubular adenocarcinomas.Cholangiocarcinomas develop through a multistep carcinogenesis and are preceded by dysplastic and in situ lesions.While clinical characteristics and management of these tumours have been extensively elucidated in literature,their ultra-structure and tumour biology remain relatively unknown.This review focuses on the current knowledge of pathological characteristics,molecular alterations of cholangiocarcinoma,and its precursor lesions(including biliary intraepithelial neoplasia,intraductal papillary neoplasms of the bile duct,intraductal tubulopapillary neoplasms and mucinous cystic neoplasm). | Mukul Vij Yogesh Puri Ashwin Rammohan Gowripriya G Rajesh Rajalingam Ilankumaran Kaliamoorthy Mohamed Rela | 2022 | World Journal of Gastrointestinal Oncology2022，14，3： | 4 |
| 7 | Clinical features and treatment of sump syndrome following hepaticojejunostomy显示文摘BACKGROUND:Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture.A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome).Despite prophylactic rotating antibiotic therapy,the cholangitic episode may be severe and life-threatening.METHODS:From 2001 to 2006,six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary sepsis.Anastomotic stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC).Barium meal showed reflux of contrast into the biliary tree in all patients.Three patients had a short jejunal Roux limb (less than 50 cm) on pre-operative imaging.RESULTS:Five patients underwent surgery and two of them had two operations.One patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux loop.Three patients had lengthening of the Roux loop;one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux loop.The latter underwent further lengthening of the Roux loop.Three patients are cholangitis-free 6,36 and 60 months after surgery;two still experience mild episodes of cholangitis.CONCLUSIONS:An adequate length of the Roux loop is important to prevent reflux.However,Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis,although generally less frequent and severe,may recur despite appropriate reconstructive or antireflux surgery.In these cases,life-long rotating antibiotics is the only available measure. | Gabriele Marangoni Amir Ali Walid Faraj Nigel Heaton Mohamed Rela | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，3： | 4 |
| 8 | Novel en-bloc resection of locally advanced hilar cholangiocarcinoma: the Rex recess approach显示文摘Loco-regional recurrence after potentially curative resection remains a problem in hilar cholangiocarcinoma. Hilar dissection risks local spillage of tumor cells leading to suboptimal disease free survival. We have developed a new technique of radical resection for hilar cholangiocarcinoma based on the distinctive anatomy of the Rex recess of the liver, which has been assessed in two patients with locally advanced hilar cholangiocarcinoma. This technique included a right hepatectomy with en-bloc resection of the hepatoduodenal ligament and portal venous reconstruction to the left portal vein at the Rex recess. Both patients had R0 resection and have been disease-free for 26 and 38 months, respectively. | Mohamed Rela Rajesh Rajalingam Vivekanandan Shanmugam Adrian O' Sullivan Mettu S Reddy Nigel Heaton | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，1： | 3 |
| 9 | Developing a donation after cardiac death risk index for adult and pediatric liver transplantation显示文摘AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index(DCD-RI) to help in prospective decision making on organ use.METHODS The model included objective data from a single institute DCD database(2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.RESULTS DCD graft survival predictors were primary indication for transplant(P = 0.066), retransplantation(P = 0.176), MELD > 25(P = 0.05), cold ischemia > 10 h(P = 0.292) and donor hepatectomy time > 60 min(P = 0.028).According to the calculated DCD-RI score three risk classes could be defined of low(DCD-RI < 1), standard(DCD-RI 2-4) and high risk(DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.CONCLUSION The DCD-RI score independently predicted graft loss(P < 0.001) and the DCD-RI class predicted graft survival(P < 0.001). | Shirin Elizabeth Khorsandi Emmanouil Giorgakis Hector Vilca-Melendez John O'Grady Michael Heneghan Varuna Aluvihare Abid Suddle Kosh Agarwal Krishna Menon Andreas Prachalias Parthi Srinivasan Mohamed Rela Wayel Jassem Nigel Heaton | 2017 | World Journal of Transplantation2017，7，3： | 3 |
| 10 | Spontaneous rupture of hepatocellular carcinoma: a Western experience显示文摘 | Narendra Battula Mansoor Madanur Oliver Priest Parthi Srinivasan John O’Grady Michael A. Heneghan Matthew Bowles Paolo Muiesan Nigel Heaton Mohamed Rela | 2009 | The American Journal of Surgery2009，，2： | 2 |
| 11 | Liver transplantation for acute intermittent porphyria:a viable treatment?显示文摘BACKGROUND:Acute intermittent porphyria (AIP) is the most common hepatic porphyria.Its clinical presentation includes severe disabling and life-threatening neurovisceral symptoms and acute psychiatric symptoms.These symptoms result from the overproduction and accumulation of porphyrin precursors,5-aminoleuvulinic acid (ALA) and porphobilinogen (PBG).The effect of medical treatment is transient and is not effective once irreversible neurological damage has occurred.Liver transplantation (LT) replaces hepatic enzymes and can restore normal excretion of ALA and PBG and prevent acute attacks.METHOD:Two cases of LT for AIP were identified retrospectively from a prospectively maintained LT database.RESULT:LT was successful with resolution of AIP in two patients who suffered from repeated acute attacks.CONCLUSION:LT can correct the underlying metabolic abnormality in AIP and improves quality of life significantly. | Faisal S Dar Koji Asai Ali Raza Haque Thomas Cherian Mohamed Rela Nigel Heaton | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，1： | 2 |
| 12 | Biliary Complications After Liver Transplantation Using Grafts from Donors After Cardiac Death: Results from a Matched Control Study in a Single Large Volume Center显示文摘 | Michelle L. DeOliveira Wayel Jassem Roberto Valente Shirin Elizabeth Khorsandi Gregorio Santori Andreas Prachalias Parthi Srinivasan Mohamed Rela Nigel Heaton | 2011 | Annals of Surgery2011，，5： | 2 |
| 13 | Lessons from look-back in acute liver failure? A single centre experience of 3300 patients显示文摘 | William Bernal Anna Hyyrylainen Amit Gera Vinod K. Audimoolam Mark J.W. McPhail Georg Auzinger Mohammed Rela Nigel Heaton John G. O’Grady Julia Wendon Roger Williams | 2013 | Journal of Hepatology2013，，1： | 2 |
| 14 | Robotic donor hepatectomy:Are we there yet?显示文摘In living donor liver transplantation(LDLT)the safety of the live donor(LD)is of paramount importance.Despite all efforts,the morbidity rates approach 25%-40%with conventional open donor hepatectomy(DH)operations.However,most of these complications are related to the operative wound and despite increased selfesteem and satisfaction in various quality of life analyses on LD,the most common grievance is that of the scar.Performing safe and precise DH through a conventional laparoscopic approach is a formidable task with a precipitous learning curve for the whole team.Due to the ramifications the donor operation carries for the donor,the recipient,the transplant team and for the LDLT program in general,the development and acceptance of minimally invasive DH(MIDH)has been slow.The robotic surgical system overcomes the reduced visualization,restricted range of motion and physiological tremor associated with laparoscopic surgery and allows for a comparatively easier transition from technical feasibility to reproducibility.However,many questions especially with regards to standardization of surgical technique,comparison of outcomes,understanding of the learning curve,etc.remain unanswered.The aim of this review is to provide insights into the evolution of MIDH and highlight the current status of robotic DH,appreciating the existing challenges and its future role. | Ashwin Rammohan Mohamed Rela | 2021 | World Journal of Gastrointestinal Surgery2021，13，7： | 2 |
| 15 | Surgical anatomy of segmental liver transplantation显示文摘 | Deshpande RR Heaton ND Rela M | 2002 | Br J Surg2002，89，9： | 1 |
| 16 | A prospective randomised trial of bile duct reconstruction at liver transplantation: T tube or no T tube?显示文摘 | V. Vougas M. Rela E. Gane P. Muiesan H. Vilca Melendez R. Williams N. D. Heaton | 1996 | Transplant International1996，，4： | 1 |
| 17 | Bile acids analysis: a tool to assess graft function in human liver transplantation显示文摘 | Hector Vilca Melendez Mohamed Rela Kenneth D. R. Setchell Gerard M. Murphy Nigel D. Heaton | 2004 | Transplant International2004，，6： | 1 |
| 18 | Hydrodynamic gene delivery to the liver; theoretical and practical issues for clinical application 显示文摘 | Sawyer GJ Rela M Davenport M | 2009 | Curr Gene Ther2009，9，： | 1 |
| 19 | The role of mitochondria in ischemia/reperfusion injury显示文摘 | Jassem W Fuggle SV Rela M | 2002 | Transplantation2002，73，4： | 1 |
| 20 | Use of infrarenal conduits for arterial revascularization in orthotopic liver transplantation 显示文摘 | Muiesan P Rela M Nodari F | 1998 | Liver Transpl Surg1998，4，3： | 1 |
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