Cherif Boutros

Omega-3 fatty acids: investigations from cytokine regulation to pancreatic cancer gene suppression.

Omega-3 (omega-3) fatty acids have been clinically and experimentally associated with the amelioration of chronic and acute inflammation; however, the mechanisms for these observations have not been well defined. During the past decade, laboratories of nutrition and inflammation have demonstrated that the anti-inflammatory activities of omega-3 fatty acids occur at least in part through the inhibition of macrophage-elaborated tumor necrosis factor production and through inactivation of the nuclear factor-kappaB signaling pathway subsequently altering proinflammatory cytokine transcription. These observations led to further experiments that support a role for omega-3 fatty acids in the restoration of apoptosis in various chemoresistant tumor models through a similar inactivation of the nuclear factor-kappaB signaling pathway. The potential for nutritional modulation of host inflammation has been an ongoing and expanding area of investigation. An increased emphasis has been placed on the potential for diet and dietary supplements to serve as modulators of host response to disease, injury, and infection.

Evaluation of a bipolar radiofrequency device for laparoscopic hepatic resection: technique and clinical experience in 18 patients

BACKGROUND The increased frequency of laparoscopic hepatic resection as a principal or adjunct component of patient care has driven the need for and development of efficient and safe hepatic parenchymal transection technologies. At present, various devices are available for pre-coagulation transection (PCT) of hepatic parenchyma with the intent of minimizing procedure-associated postoperative haemorrhage and bile leak. This report presents the evaluation of a novel bipolar radiofrequency (RF) energy device for PCT used for laparoscopic hepatic resection. METHODS Patients undergoing laparoscopic hepatic resection using the Enseal device (SurgRx Inc.) were identified from the prospectively maintained hepatobiliary database. Information on patient demographics, procedures and postoperative complications was collected and analysed; complications were grouped into early (at <30 days) and late (at > or = 30 days) events. RESULTS A total of 18 patients, of whom 13 had malignant tumours (12 colorectal metastases and one hepatocellular carcinoma) and five had benign tumours (two hepatic adenomas and three haemangiomas) underwent 18 hepatic procedures, including two formal hemi-hepatectomies, four left lateral sections, three posterior sections and nine atypical non-anatomic resections. Estimated blood loss did not differ from institutional historical control data; no postoperative haemorrhage, bile leaks or hepatic abscess or necrosis were identified (n = 18). CONCLUSIONS This initial experience using the laparoscopic bipolar RF device demonstrates an acceptable safety profile in terms of the outcomes analysed.

Assessment of clinical benefit and quality of life in patients undergoing cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for management of peritoneal metastases.

Peritoneal metastasis is a significant clinical challenge; life expectancy following diagnosis is usually very short. Surgical cytoreduction with HIPEC is being used with increasing frequency in selected patients; most outcome data have shown that prolonged median survivals can be observed in selected patients. This review summarizes the published data related to outcome and quality of life after cytoreduction and HIPEC to provide insights into its use in patients with peritoneal carcinomatosis.

Extrahepatic Cholangiocarcinoma: Current Surgical Strategy

Cholangiocarcinoma is a rare cancer. Although rare, it remains the second most common hepatobiliary cancer and its incidence is increasing worldwide. Extrahepatic cholangiocarcinoma can occur anywhere along the biliary tree and prognosis varies according to the location of disease.

The Role of Minimally Invasive Surgery in Gallbladder Carcinoma, is it Timeto Change our Approach?

The safety and utility of the laparoscopic approach to definitive gallbladder . Within the last 5 years, safely performed laparoscopic extended resections in specialized centers have begun to be published as well. The aim of this review is to revisit the dogma of only open surgical approach for gallbladder cancer. Traditional limitations and restraints of minimally invasive approach are discussed and advance in laparoscopic hepatobiliary surgery is emphasized.

Biliary and gastric drainage in advanced pancreatic serous cystadenoma and portal hypertension in Von Hippel-Lindau syndrome

Von Hippel-Lindau is a genetic syndrome, comprising several variant mutations on chromosome 3, that predisposes patients to the development of benign and malignant tumors. Tough relatively common, Von Hippel-Lindau syndrome (VHL) with associated hepato-biliary and gastric outlet obstruction, and portal hypertension consequent to the mass effect of a pancreatic serous cystadenoma is a rare scenario. This manuscript reports a 41-year-old female with the aforementioned presentation who successfully underwent a palliative cholecysto- and a gastro-jejunostomy. To the knowledge of the authors, this is the only report, describing a palliative biliary decompression for VHL-related pancreatic serous cystadenoma and portal hypertension.

T1595 Cystogastrostomy, Retroperitoneal Drainage and G-J Entereal Alimentation for Complex Pancreatitis-Associated Pseudocyst: 19 Patients with No Recurrence

Introduction: Various techniques have been described to achieve resolution without recurrence of complex acute pancreatitis associated pseudocysts (PAC). Many strategies, inclusive of open, minimally invasive and radiological procedures are hampered by high recurrence or failed resolution, particularly for PAC near the pancreatic head. The present series describes a multimodal strategy combining open anterior gastrostomy for the creation of a stapled posterior cystogastrostomy, placement of an 8 french secured silastic tube for intentional formation of a cystogastric fistula tract in combination with gastric drainage and post duodenal enteral alimentation. Material and Methods: Using a prospectively maintained hepatobiliary database, patients with complex PAC undergoing the above management were identified. PAC location, postoperative length of stay (LOS), time to enteral were identified. PAC were assessed by CT scan prior to operation, one month after drainage and patients with PAC resolution were started on oral diet, with the fistula silastic tube kept in place for an additional month. Results: Over the interval 2003-2008, 19 patients were managed with the stated strategy. PACs were located at the pancreatic body/tail in 12 patients and 7 patients had PAC at the level of the pancreatic head/neck area.17/19 had undergone ERCP with decompression stent placement and 13/19 had a failed percutaneous drainage. There was no perioperative mortality after open surgical drainage. All patients started on jejunal tube feeding 24 hs after surgical procedure. Median postoperative LOS was 7 days (4-13). At one month 16/19 (84%) of patients showed complete resolution of the PAC on CT scan and were started on oral diet, 3/19 required additional month for complete resolution. There were no PAC recurrences in any of these patients demonstrated on follow up. Conclusion: The described strategy is safe, efficient and allows early restoration of enteral feeding with early hospital discharge. High resolution rates and absence of PAC recurrences in this series support s this approach for complex PAC.