FABIO FERRARI MAKDISSI
Índice h a partir de 2011
12
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
39 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 39
- Laparoscopic Pancreatoduodenectomy in 50 Consecutive Patients with No Mortality: A Single-Center Experience(2016) MACHADO, Marcel Autran C.; SURJAN, Rodrigo C.; BASSERES, Tiago; SILVA, Izabella B.; MAKDISSI, Fabio F.Background: Laparoscopic pancreatic surgery has gradually expanded to include pancreatoduodenectomy (PD). This study presents data regarding the efficacy of laparoscopic PD in a single center. Methods: This was a single-cohort, prospective observational study. From March 2012 to September 2015, 50 consecutive patients underwent laparoscopic PD using a five-trocar technique. Reconstruction of the digestive tract was performed with double jejunal loop technique whenever feasible. Patients with radiological signs of portal vein invasion were operated by open approach. Results: Twenty-seven women and 23 men with a median age of 63 years (range 23-76) underwent laparoscopic PD. Five patients underwent total pancreatectomy. All, but 1 patient (previous bariatric operation), underwent pylorus-preserving resection. Reconstruction was performed with double jejunal loop in all cases except in 5 cases of total pancreatectomy. Conversion was required in 3 patients (6%) as a result of difficult dissection (two cases) and unsuspected portal vein invasion (1 patient). Median operative time was 420 minutes (range 360-660), and the 90-day mortality was nil. Pancreatic fistula occurred in 13 patients (26%). There was one grade C (reoperated), one grade B (percutaneous drainage), and all remaining were grade A (conservative treatment). Other complications included port site bleeding (n = 1), biliary fistula (n = 2), and delayed gastric emptying (n = 2). Mean hospital stay was 8.4 days (range 5-31). Conclusions: Laparoscopic PD is feasible and safe, but is technically demanding and may be reserved to highly skilled laparoscopic surgeons with proper training in high-volume centers. Isolated pancreatic anastomosis may be useful to decrease the severity of postoperative pancreatic fistulas. Therefore, it could be a good option in patients with a high risk for developing postoperative pancreatic, as well as by less-experienced surgeons.
- Robotic ALPPS(2020) MACHADO, Marcel Autran C.; SURJAN, Rodrigo C.; MAKDISSI, FabioBackground The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure is a useful strategy to treat patients with advanced liver tumors and small future liver remnants. This video presents a robotic ALPPS procedure to treat synchronous colorectal liver metastases. Methods A 71-year-old man with liver metastases from sigmoid cancer was referred. A multidisciplinary team decided on chemotherapy followed by liver resection (first), then colon resection. After four cycles, objective response was observed and the multidisciplinary team then chose the ALPPS procedure. The future liver remnant (segments 3 and 4 and the Spiegel lobe) was 24%. A robotic approach was proposed. Colon resection was performed after the ALPPS procedure, also using the robotic approach. Results The duration of the first stage was 293 min, and the technique used in the first stage was partial ALPPS (parenchymal transection deep to 2 cm above the inferior vena cava) with preservation of the right hepatic duct. The patient was discharged on the fourth day. The second stage of the procedure took 245 min. Recovery was uneventful and the patient was discharged on the fourth day. Finally, the patient underwent robotic resection of the primary colorectal neoplasm. The surgery lasted 182 min, recovery was uneventful, and the patient was discharged on the fifth postoperative day. Final pathology disclosed a T3N1bM1 adenocarcinoma. Liver pathology confirmed colorectal metastases with partial response. All surgical margins were free. Currently, the patient is well, with no signs of disease 5 months post-procedure. Conclusions Robotic ALPPS is feasible and safe. The robotic approach may have some advantages over the laparoscopic and open ALPPS approaches. This video may help oncological surgeons to perform this complex procedure.
- Laparoscopic Pylorus-Preserving Pancreatoduodenectomy with Double Jejunal Loop Reconstruction: An Old Trick for a New Dog(2013) MACHADO, Marcel Autran C.; MAKDISSI, Fabio F.; SURJAN, Rodrigo C. T.; MACHADO, Marcel C. C.Background: Pancreatoduodenectomy is an established procedure for the treatment of benign and malignant diseases located at the pancreatic head and periampullary region. In order to decrease morbidity and mortality, we devised a unique technique using two different jejunal loops to avoid activation of pancreatic juice by biliary secretion and therefore reduce the severity of pancreatic fistula. This technique has been used for open pancreatoduodenectomy worldwide but to date has never been described for laparoscopic pancreatoduodenectomy. This article reports the technique of laparoscopic pylorus-preserving pancreatoduodenectomy with two jejunal loops for reconstruction of the alimentary tract. Materials and Methods: After pancreatic head resection, retrocolic end-to-side pancreaticojejunostomy with duct-to-mucosa anastomosis is performed. The jejunal loop is divided with a stapler, and side-to-side jejunojejunostomy is performed with the stapler, leaving a 40-cm jejunal loop for retrocolic hepaticojejunostomy. Finally, end-to-side duodenojejunostomy is performed in an antecolic fashion. Results: This technique has been successfully used in 3 consecutive patients with pancreatic head tumors: 2 patients underwent hand-assisted laparoscopic pylorus-preserving pancreatoduodenectomy, and 1 patient underwent totally laparoscopic pylorus-preserving pancreatoduodenectomy. One patient presented a Grade A pancreatic fistula that was managed conservatively. One patient received blood transfusion. Mean operative time was 9 hours. Mean hospital stay was 7 days. No postoperative mortality was observed. Conclusions: Laparoscopic pylorus-preserving pancreatoduodenectomy with double jejunal loop reconstruction is feasible and may be useful to decrease morbidity and mortality after pancreatoduodenectomy. This operation is challenging and may be reserved for highly skilled laparoscopic surgeons.
- A novel technique for hepatic vein reconstruction during hepatectomy(2016) SURJAN, Rodrigo C.; BASSERES, Tiago; PAJECKI, Denis; PUZZO, Daniel B.; MAKDISSI, Fabio F.; MACHADO, Marcel A. C.; BATTILANA, Alexandre Gustavo BellorioSurgical resection is the treatment of choice for malignant liver tumours. Nevertheless, surgical approach to tumours located close to the confluence of the hepatic veins is a challenging issue. Trisectionectomies are considered the first curative option for treatment of these tumours. However, those procedures are associated with high morbidity and mortality rates primarily due to post-operative liver failure. Thus, maximal preservation of functional liver parenchyma should always be attempted. We describe the isolated resection of Segment 8 for the treatment of a tumour involving the right hepatic vein and in contact with the middle hepatic vein and retrohepatic vena cava with immediate reconstruction of the right hepatic vein with a vascular graft. This is the first time this type of reconstruction was performed, and it allowed to preserve all but one of the hepatic segments with normal venous outflow. This innovative technique is a fast and safe method to reconstruct hepatic veins.
- Enucleation of liver tumors: you do not have to feel blue about it(2015) SURJAN, Rodrigo C.; MAKDISSI, Fabio F.; BASSERES, Tiago; MACHADO, Marcel A. C.Enucleation of hepatic tumors is a low-morbidity technique with adequate oncological results that is useful in many clinical settings. Compared with anatomical liver resections, it offers the advantage of maximal hepatic parenchymal preservation. However, some technical adversities may occur during the enucleation of liver tumors, such as difficulty in finding the lesions by intraoperative ultrasonography after hepatic transection or further visually spotting the tumor within the parenchyma if a first specimen is retracted not containing the lesion. We describe an innovative technique that overcomes these possible adversities and makes the enucleation of liver tumors easier and more precise.
- LAPAROSCOPIC UNCINATECTOMY: A MORE CONSERVATIVE APPROACH TO THE UNCINATE PROCESS OF THE PANCREAS(2017) SURJAN, Rodrigo Cañada; BASSERES, Tiago; MAKDISSI, Fabio Ferrari; MACHADO, Marcel Autran Cesar; ARDENGH, José CelsoABSTRACT Background: The isolate resection of the uncinate process of the pancreas is a rarely described procedure but is an adequate surgery to treat benign and low grade malignancies of the uncinate process of the pancreas. Aim: To detail laparoscopic uncinatectomy technique and present the initial results. Method: Patient is placed in supine position with the surgeon between legs. Three 5-mm, one 10-mm and one 12-mm trocars were used to perform the isolated resection of the uncinate process of the pancreas. Parenchymal transection is performed with harmonic scalpel. A hemostatic absorbable tissue is deployed over the area previously occupied by the uncinate process. A Waterman drain is placed. Result: This procedure was applied to an asymptomatic 62-year-old male with biopsy proven low grade neuroendocrine tumor of the pancreatic uncinate process. A laparoscopic pancreaticoduodenectomy was proposed. During the initial surgical evaluation, intraoperative sonography was performed and disclosed that the lesion was a few millimeters away from the Wirsung. The option was to perform a laparoscopic uncinatectomy. Postoperative period until full recovery was swift and uneventful. Conclusion: Laparoscopic uncinatectomy is a safe and efficient procedure when performed by surgical teams with large experience in minimally invasive biliopancreatic procedures.
- HEPATOSPLENIC SCHISTOSOMIASIS-ASSOCIATED CHRONIC PORTAL VEIN THROMBOSIS: RISK FACTOR FOR HEPATOCELLULAR CARCINOMA?(2023) DARCE, George Felipe Bezerra; MAKDISSI, Fabio Ferrari; ANDO, Sabrina de Mello; FONSECA, Gilton Marques; KRUGER, Jaime Arthur Pirola; COELHO, Fabricio Ferreira; ROCHA, Manoel de Souza; HERMAN, PauloBACKGROUND: Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis. AIMS: To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up. METHODS: A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021. RESULTS: A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5-31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before. CONCLUSIONS: The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients.
- Laparoscopic glissonean approach: Making complex something easy or making suitable the unsuitable?(2020) MACHADO, Marcel A.; MAKDISSI, Fabio; SURJAN, RodrigoBackground: The use of laparoscopic glissonean approach has many potential benefits such as shorter operative times, lower blood loss with low morbidity. Methods: The aim with this study was to perform an evaluation of 12 years of our experience with laparoscopic glissonean approach in liver surgery, from a technical standpoint using a prospective database. Anatomical laparoscopic liver resections using hilar dissection and non-anatomical resections were excluded from this study. Results: 327 patients (170 females and 157 males) with mean age of 56 years were included. 196 (60%) of procedures were major resections. 65% of procedures were performed in the last 5 years. 208 patients were operated on for secondary lesions. In 38 patients the liver was cirrhotic. Morbidity was 37.3% and 90-day mortality occurred in 2 patients (0.6%). Blood transfusion was necessary in 10.7% of patients. Median hospital stay was 4 days. Conclusions: Laparoscopic glissonean approach is a safe and feasible technique. It may be preferred in some clinical situations as it is associated with shorter operative times, lower blood loss, and low morbidity. It is superior to standard laparoscopic hepatectomy when an anatomical resection, especially if a segment or section is to be removed. However, application of this technique requires accurate preoperative tumor localization, identification of potential anatomic pedicle variations, as well as surgeon expertise.
- Totally Laparoscopic Right Hepatectomy with Roux-en-Y Hepaticojejunostomy for Right-Sided Intraductal Papillary Mucinous Neoplasm of the Bile Duct(2014) MACHADO, Marcel Autran; MAKDISSI, Fabio F.; SURJAN, Rodrigo C.Intraductal papillary neoplasm of the bile duct is a precursor lesion of cholangiocarcinoma. We present a video of a totally laparoscopic right hepatectomy with hilar dissection and lymphadenectomy, en-bloc resection of the extrahepatic bile duct, and Roux-en-Y hepaticojejunostomy in a patient with intraductal papillary neoplasm of the right hepatic duct. A 58-year-old woman with right upper quadrant pain was referred for evaluation. Abdominal ultrasonography revealed dilatation of intrahepatic and extrahepatic bile ducts. Magnetic resonance imaging showed a stop in the right bile duct, with dilatation of the distal bile duct. The decision was to perform a totally laparoscopic right hepatectomy with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy. The operative time was 400 min. Estimated blood loss was 400 ml, without the need for transfusions. Postoperative recovery was uneventful, and the patient was discharged on the 10th postoperative day. The abdominal drain was removed on the 14th postoperative drain with no signs of biliary leakage. Final pathology confirmed the diagnosis of intraductal papillary neoplasm without malignant transformation. Surgical margins were free. Patient is well with no evidence of the disease 14 months after the procedure. Laparoscopic right hepatectomy with hepaticojejunostomy is feasible and safe, provided it is performed in a specialized center and with staff with experience in hepatobiliary surgery and advanced laparoscopic surgery. Currently this operation is reserved for selected cases. This video can help oncologic surgeons to perform this complex procedure.
- Two decades of liver resection with a multidisciplinary approach in a single institution: What has changed? Analysis of 1409 cases(2022) HERMAN, Paulo; FONSECA, Gilton Marques; COELHO, Fabricio Ferreira; KRUGER, Jaime Arthur Pirola; MAKDISSI, Fabio Ferrari; JEISMANN, Vagner Birk; CARRILHO, Flair Jose; D'ALBUQUERQUE, Luiz Augusto Carneiro; NAHAS, Sergio CarlosObjectives: To evaluate results of patients undergoing liver resection in a single center over the past two decades with a particular look at Colorectal Liver Metastasis (CRLM) and Hepatocellular Carcinoma (HCC). Method: Patients were divided into two eras, from 2000 to 2010 (Era 1) and 2011 to 2020 (Era 2). The most frequent diagnosis was CRLM and HCC, with 738 (52.4%) and 227 (16.1%) cases respectively. An evaluation of all liver resection cases and a subgroup analysis of both CRLM and HCC were performed. Preoperative and per operative variables and long-term outcomes were evaluated. Results: 1409 liver resections were performed. In Era 2 the authors observed higher BMI, more: minimally invasive surgeries, Pringle maneuvers, and minor liver resections; and less transfusion, less ICU necessity, and shorter length of hospital stay. Severe complications were observed in 14.7% of patients, and 90-day mortality was 4.2%. Morbidity and mortality between eras were not different. From 738 CRLM resections, in Era 2 there were significantly more patients submitted to neoadjuvant chemotherapy, bilateral metastases, and smaller sizes with significantly less transfusion, the necessity of ICU, and shorter length of hospital stay. More pedicle clamping, minimally invasive surgeries, and minor resections were also observed. From 227 HCC resections, in Era 2 significantly more minimally invasive surgeries, fewer transfusions, less necessity of ICU, and shorter length of hospital stay were observed. OS was not different between eras for CRLM and HCC. Conclusions: Surgical resection in a multidisciplinary environment remains the cornerstone for the curative treatment of primary and metastatic liver tumors.