The present study documents the indications and results of endoscopic sphincterotomy (ES) performed over 7 years in a surgical endoscopy unit. Potential improvement of results over this time period was analyzed. ES was associated with rare but undesirable morbidity and mortality. Specific improvement of results over time has not been reported. ES was attempted in 706 patients (336 men, 370 women) from 1987 to 1994 and was accomplished in 689 patients (97.6%). Complications occurred in 50 patients (7.1%), 13 of whom required emergency operative intervention. The overall 30-day mortality was 4.7% (n = 33), and procedure-related mortality was 0.7% (n = 5). There was a significant decrease in hospital mortality (p < 0.01) and operative intervention for procedure-related complications (P < 0.001) after 1990. Procedure-related mortality has been reduced from 1.3% to 0.3% since 1990 (p = 0.1). ES in emergency situations or for malignant biliary obstruction did not adversely affect the outcome. It was concluded that ES can be performed safely in most patients. With increasing experience, procedure-related morbidity and mortality can possibly be reduced.

Chung Yau Lo;Edward C.S. Lai;Chung Mau Lo;Francis P.T. Mok;Kent Man Chu;Chi Leung Liu;上达 范

World Journal of Surgery

1997

Electrohydraulic lithotripsy has been safely applied in two patients with impacted stones at the lower end of the common bile duct. If definitive biliary drainage operation is not indicated, electrohydraulic lithotripsy is an effective alternative to transduodenal sphincteroplasty.

上达 范

Surgery Gynecology and Obstetrics

1989

上达 范;Edward C.S. Lai;Chung Mau Lo;Irene O.L. Ng;John Wong

Archives of Surgery

1995-2

Background. Cadaveric liver donors are scarce in Hong Kong, and the application of liver transplantation to high-urgency patients is limited. We evaluated the use of grafts from living donors in this setting. Methods. From July 1994 to January 1998, 49 consecutive adult patients who were intensive care unit-bound because of acute or chronic liver failure were put on a high- urgency list for liver transplantation. Family members were not solicited for living donation, and the initiation and decision for living donor liver transplantation (LDLT) was based on the donor's voluntary intent. Assessment of the living donor, including blood tests, computed tomographic volumetry, and angiography, was performed only after informed consent was executed. Results. In 25 of 49 (51%) patients, no family member volunteered as living donor; 23 died awaiting donor organs, and 2 received a cadaveric graft. Twenty-four (49%) patients had 36 family members who volunteered as living donors. Before evaluation of living donor was completed, two patients received a cadaveric liver transplant. LDLT was not performed in nine patients because of recipient contraindications (n=4), ABO blood group incompatibility (n=3), and withdrawal of donor (n=2). Eight of these nine patients died, and one received a cadaveric liver graft. The remaining 13 (27%) patients received grafts from living donors. Four of 5 (80%) patients who underwent cadaveric liver transplantation and 11 of 13 (85%) who underwent LDLT survived. Thus, emergency transplantation from living donors increased the applicability of liver transplantation from 10% to 37%, and the survival rate after emergency LDLT (85%) was superior to that of the remaining patients (11%). Conclusions. When cadaveric organ donation is scarce, emergency liver transplantation from living donors can be applied to high-urgency adult patients.

Chung Mau Lo;上达 范;Chi Leung Liu;Willian I. Wei;John K. Chan;Ching Lung Lai;George K. Lau;John Wong

Transplantation

1999-1-15

上达 范;Chi Leung Liu

Annals of Surgery

2008-2

There is a significant shortage of deceased liver grafts for paediatric patients worldwide. In Hong Kong, this problem is even more severe. In order to expand the donor pool, various methods have been used. Split-graft liver transplant is one of the potential ways to effectively increase the number of deceased donor grafts. Here, we present a review of our experience of using split-grafts for children in Hong Kong.

P. H.Y. Chung;K. K.Y. Wong;P. K.H. Tam;K. L. Chan;K. K.C. Ng;S. C. Chan;T. W.C. Hui;B. H. Yong;上达 范;C. M. Lo

Hong Kong Journal of Paediatrics

2009

OBJECTIVE: Variceal bleeding is an important manifestation of hepatocellular carcinoma (HCC). However, little has been documented in the literature regarding the outcomes of HCC patients presenting with variceal bleeding. This study evaluated the clinical characteristics, management, and outcomes of this specific group of patients. METHODS: A retrospective analysis of a prospectively collected database comprising 2,928 HCC patients managed from January 1989 to December 2002 identified 78 patients who had presented with variceal bleeding. Their clinical outcomes were compared to those patients who did not present with variceal bleeding, and a multivariate analysis was performed to identify prognostic factors for their survival. RESULTS: HCC patients who presented with variceal bleeding had more severe cirrhosis than those who did not, with a significantly higher serum bilirubin level, lower albumin level, lower platelet count, and longer prothrombin time. They had significantly smaller HCCs but more frequent portal vein thrombosis. There was a significant difference in the overall survival between HCC patients who presented with variceal bleeding and those who did not (median 3.5 months vs 7.5 months, p < 0.001). In the variceal bleeding group, by multivariate analysis, treatment with transarterial chemoembolization was the only significant independent prognostic factor for survival (odds ratio 17.16, 95% CI: 2.81-104.91, p = 0.002). CONCLUSIONS: HCC patients who presented with variceal bleeding can be expected to have a significantly worse survival outcome than the general HCC patients. However, transarterial chemoembolization may offer some survival benefit to a selected group of HCC patients presenting with variceal bleeding.

Brian H. Lang;Ronnie T. Poon;上达 范;John Wong

American Journal of Gastroenterology

2004-11

This study aims to clarify the role of heme oxygenase-1 (HO-1) in small-for-size liver transplantation. Transplantation was performed using 40% small-for-size or 100% whole liver grafts in rats. When no treatment was given, over-expression of HO-1 was detected predominantly in the small-for-size grafts at 6 hours after reperfusion as compared to whole grafts in both syngeneic and allogeneic combinations. Recombinant adenoviral vector encoding HO-1 gene (AdHO-1) administered to donors 48 hours before transplantation enhanced HO-1 expression in both whole and small-for-size allografts, with a predominant augmentation in the small-for-size allografts, suggesting favorable conditions for the induction of HO-1 expression in small-for-size allografts. In close relation to the expression level of HO-1, AdHO-1 significantly prolonged both whole and small-for size allograft survivals, with a remarkable effect in the small-for-size allograft group. The prolongation of allograft survival was blocked by the HO-1 inhibitor (zinc protoprophyrin IX). The non-treated small-for-size allografts demonstrated impaired liver function during the early period after reperfusion, which could be improved by over-expression of HO-1, but reversed by the HO-1 inhibitor. The markedly increase expression HO-1 in small-for-size allografts was associated with lower levels of adhesion molecules and pro-inflammatory cytokines in the early phase after reperfusion. These findings support the beneficial effects of HO-1 on allograft survival. In conclusion, the ability of small-for-size grafts in the induction of HO-1 expression might facilitate their own survival in liver transplantation.

Zhen Fan Yang;Tung Yu Tsui;David W. Ho;Terence C. Tang;上达 范

Liver Transplantation

2004-6

Pancreatic neuroendocrine tumor is an uncommon disease, and surgery is the only potentially curative treatment even when there is hepatic metastasis. A patient undergoing concomitant laparoscopic distal pancreatectomy and hepatectomy for pancreatic polypeptidoma with a solitary liver metastasis is reported.

W. F. Chan;C. Y. Lo;C. M. Lo;上达 范

Surgical Endoscopy and Other Interventional Techniques

2004-3

Post-transplantation lymphoproliferative disease (PTLD) is an unique iatrogenic complication after bone marrow transplantation (BMT) and solid organ transplantation (SOTx). The pattern of EBV related lymphoma in Chinese is different from Caucasians. We surveyed the incidence, clinical and pathological spectrum of PTLD among 541 cases of allogeneic BMT, 145 cases of renal transplant, 35 cases of heart/lung transplantation and 146 cases of orthotopic liver transplantation (OLT). From 1994 to 2001, 13 consecutive cases of PTLD were diagnosed, ranging from disseminated NK cell lymphoma to localized plasmacytoma. Both donor and recipient derived PTLD was documented. Disease was often heralded by cytomegaloviral disease and antithymocyte globulin (ATG) usage. Two cases were diagnosed post-mortem, and six patients died of PTLD at a median of 3 months. Complete and partial remission was only achieved in 3 and 2 cases, respectively, despite a range of treatment (reduced immuosuppression, explantation, radiotherapy, combination chemotherapy, donor lymphocytes, autologous marrow infusion and rituximab). Most responding patients died subsequently of rejection, infection and graft versus host disease (GVHD). The incidence of PTLD is not increased in Chinese patients. However, some patients may be at increased risk, especially mismatched allogeneic BMT, parental OLT (especially involving young infants) and heavy ATG exposure.

W. Y. Au;A. K.W. Lie;Y. L. Kwong;T. W. Shek;B. R. Hawkins;K. N. Lai;S. C.W. Tang;C. M. Lo;上达 范;C. L. Liu;G. C.F. Chan;E. M.C. Chau;S. W. Chiu;R. Liang

Leukemia and Lymphoma

2002