Hieu Trung 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.

Introduction: Bilothorax is a rare and poorly documented condition in the medical literature, with following hepatobiliary procedures being the most common cause. We present a case of bilothorax following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Case presentation: A 71-year-old woman with a history of prior percutaneous biliary stone removals presented with Charcot's triad and was diagnosed with cholangitis due to a distal common bile duct stone. She underwent ERCP with successful stone extraction and stent placement. Two days later, she developed a right-sided pleural effusion diagnosed as a post-ERCP bilothorax. She was treated with thoracentesis and antibiotics, and her condition significantly improved. After 15 days, she was discharged, and a one-month follow-up showed no complications or recurrence. Clinical discussion: Bile is a potent chemo irritant that can cause adhesive pleurodesis. Besides, accompanying cholangitis can lead to pleural infection and empyema. In this patient, early diagnosis leading to timely pleural drainage decisions helped avoid potential consequences. Conclusion: Post-ERCP bilothorax is a rare complication but can lead to severe consequences. Nonoperative management by pleural drainage is a safe and effective strategy if diagnosis is made early, helping patients avoid more invasive interventions. Highlights:

Introduction: Intrahepatic and extrahepatic lithiasis, a condition characterized by the presence of stones in the liver and bile ducts, is a common disease in Asia, particularly in East and Southeast Asia. We report a case with laparoscopic exploration of the common bile duct using a flexible cholangioscope and modified trans-common bile duct tunnel for hepatolithiasis combined with the dilated common bile duct. Presentation of case: A 35-year-old male patient has had chronic epigastric and right upper quadrant pain. The common bile duct was 11 mm dilated, and hepatolithiasis was also present, according to an upper abdomen MRI. The largest stone measured between 14 and 21 mm. A modified trans-common bile duct tunnel from the abdominal wall into the common bile duct was used in a laparoscopic procedure to examine the common bile duct. Complications during the procedure or following it were not present. The procedure took 120 min, and the blood loss was about 50 ml. The patient was discharged on the sixth postoperative day, and a follow-up visit one month later revealed that single-session stone clearance had been accomplished. Discussion: Laparoscopic exploration of the common bile duct using a cholangioscope and modified trans-choledochal tube is applicable in selected patients and can be effectively and safely used to treat hepatolithiasis combined with the dilated common bile duct. Conclusion: In this case, we present an innovative approach for hepatolithiasis when combined with dilated common bile duct. Highlights:

Introduction: Acute-on-chronic liver failure (ACLF) has a high mortality rate, and liver transplantation is considered a definite treatment for patients with this condition. This study aims to evaluate the outcomes of living donor liver transplantation (LDLT) in ACLF patients in a single centre in a lower middle-income country, Vietnam. Materials and methods: This was a retrospective study at the 108 Military Central Hospital (Hanoi, Vietnam), enroling 51 patients diagnosed with ACLF based on Asian Pacific Association for the Study of the Liver (APASL) criteria who underwent LDLT with a right lobe graft from December 2019 to December 2022. The authors utilize the model for end-stage liver disease (MELD) and APASL ACLF Research Consortium (AARC) scores to evaluate and stratify the severity of ACLF. Results: The average age of all patients was 47.27±13.61, with 88.24% being male. The average BMI was 22.78±2.61. The most common underlying liver disease was chronic viral hepatitis B (88.2%). The average MELD score of the patients was 34.90±5.61, with 33.3% having MELD score greater than or equal to 40. In terms of ACLF severity, five patients (9.8%) had grade I ACLF, 35 patients (68.6%) had grade II ACLF, and 11 patients (21.6%) had grade III ACLF. The average AARC score was 9.43±1.68. The duration of treatment in the ICU was 8.59±7.27 days, and the length of hospital stay was 28.02±13.45 days. The most common post-transplant complication was biliary complication (19.61%). Death occurred in 7 patients (13.7%). The survival rates at 6 months, 1 year, and 3 years were 84%, 81.7%, and 81.7%, respectively. Conclusion: Living donor liver transplantation for ACLF patients is safe and has a high post-transplant survival rate. Multidisciplinary care before, during, and after surgery, and the decision to do a liver transplant early, is essential in saving the lives of ACLF patients.

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

The Duy Nguyen, Van Quang Vu, Trung Hieu Le, Van Thanh Le. Korean J Transplant 2023;37:87. https://doi.org/10.4285/ATW2023.F-6687

Glucomannan/graphene oxide (GM/GO) hydrogel was synthesized by using calcium hydroxide as the crosslinker. The synthesized material was characterized by using IR, XRD, SEM, EDX and RAMAN technology. The composite hydrogel was used for removal of organic dyes from aqueous solution. The results showed that the GM/GO hydrogel had a porous structure and a high adsorption capacity toward methylene blue (MB). The pseudo-second-order kinetic model could fit the rate equation of MB adsorption onto the GM/GO hydrogel. The adsorption of MB onto GM/GO hydrogel was a spontaneous process. In addition, the equilibrium adsorption isotherm data indicated that equilibrium data were fitted to the Langmuir isotherm and the maximum dye adsorption capacity was 198,69 mg.g^-1. Moreover, the hydrogel was stable and easily recovered and adsorption capacity was around 97% of the initial saturation adsorption capacity after being used five times.