Thanh Van Le

Introduction: Hepatic artery complications after liver transplantation are uncommon but potentially catastrophic because the biliary tree depends entirely on the arterial blood supply. Graft hepatic artery dissection (GHAD) is extremely rare following living donor liver transplantation (LDLT), and optimal management strategies remain unclear. Case presentation: A 68-year-old man with hepatocellular carcinoma and underlying alcohol-related cirrhosis underwent right-lobe LDLT. During donor hepatectomy, intimal dissection of the graft hepatic artery, extending deep into the liver parenchyma, was identified. After arterial reconstruction, intraoperative Doppler ultrasound demonstrated absent arterial flow. The abdomen was closed, and the patient was transferred for urgent endovascular intervention. Angiography confirmed compromised arterial inflow, and a drug-eluting stent was deployed across the arterial anastomosis, followed by catheter-directed thrombolysis using alteplase. Postoperatively, the patient developed intra-abdominal bleeding requiring emergency re-laparotomy for hemostasis. Despite this complication, hepatic arterial perfusion was successfully restored. Liver function gradually improved, and follow-up imaging confirmed adequate graft perfusion. The patient was discharged 3 weeks after transplantation with preserved graft function. Discussion: GHAD is a rare but serious vascular complication that may result in graft ischemia, biliary complications, and graft failure if not promptly treated. When surgical revision is not feasible, endovascular techniques – including stent placement and thrombolysis – can serve as effective salvage strategies. However, thrombolytic therapy carries a significant risk of hemorrhagic complications, requiring careful postoperative monitoring. Conclusion: Early diagnosis and multidisciplinary management are essential for the successful salvage of GHAD after LDLT.

Original Article Laparoscopic left-sided hepatectomy guided by dilated bile ducts as anatomical landmarks for hepatolithiasis: a single-center preliminary study Hieu Trung Le, Quang Van Vu, Thanh Van Le, Thang Manh Tran, Quynh Van Nguyen

Hieu Trung Le, Quang Van Vu, Thanh Van Le, Thang Manh Tran. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.25-109

Introduction: Situs inversus totalis (SIT) is a rare congenital anomaly in which thoracic and abdominal organs are mirrored from normal positions. Hepatolithiasis, common in East and Southeast Asia, often requires hepatectomy for localized disease with parenchymal atrophy. Laparoscopic approaches in SIT patients are challenging due to reversed anatomy and ergonomics. This report presents the first case of laparoscopic anatomical left hepatectomy for hepatolithiasis in a SIT patient, guided by the dilated bile duct and middle hepatic vein. Materials and Surgical Technique: A 57‐year‐old woman with SIT presented with recurrent cholangitis. Imaging showed multiple intrahepatic stones, strictures, and severe left liver atrophy, indicating localized disease. Laparoscopic left hepatectomy was performed with adaptations: mirrored trocar placement, French positioning, and dissection using the dilated bile duct and middle hepatic vein as anatomical landmarks. The procedure ensured safe navigation of mirror‐image anatomy. Discussion: The surgery was completed with minimal blood loss and no complications; the patient was discharged on postoperative day six and remained asymptomatic at follow‐up. This case highlights that meticulous preoperative planning, ergonomic adjustments, and bile duct–oriented resection enable safe laparoscopic hepatectomy in SIT, achieving complete stone clearance and reducing recurrence risk in complex hepatolithiasis scenarios.

Loi Van Le, Quang Van Vu, Thanh Van Le, Hieu Trung Le, Khue Kim Dang, Tuan Ngoc Vu, Anh Hoang Ngoc Nguyen, Thang Manh Tran. Ann Hepatobiliary Pancreat Surg 2024;28:42-7. https://doi.org/10.14701/ahbps.23-085

There has been marked improvement in leukemia survival, particularly among children in recent time. However, the long-term trends in survival among adult leukemia patients and the associated sex and racial survival disparities are not well understood. We, therefore, evaluated the secular trends in survival improvement of leukemia patients from 1973 through 2014, using Surveillance Epidemiology and End-Result Survey Program (SEER) data. ICD-O-3 morphology codes were used to group leukemia into four types: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML). Survival analysis for each leukemia type stratified by race/ethnicity, age, sex was performed to generate relative survival probability estimates for the baseline time period of 1973 through 1979. Hazard ratios (HR) and respective 95% confidence intervals (CIs) for survival within subsequent 10-year time periods by race, age and sex were calculated using Cox proportional hazard models. Of the 83,255 leukemia patients for the current analysis, the 5-year survival of patients with ALL, AML, CLL, and CML during 1973–1979 were 42.0%, 6.5%, 66.5%, and 20.9%, respectively. Compared to the baseline, there were substantial improvements of leukemia-specific survival in 2010–2014 among African-American (81.0%) and Asian (80.0%) patients with CML and among 20–49 year of age with CLL (96.0%). African-American patients, those with AML and those older than 75 years of age had the lowest survival improvements. Asians experienced some of the largest survival improvements during the study period. Others, including African-American and the elderly, have not benefited as much from advances in leukemia treatment.