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HEPATIC VENO-OCCLUSIVE DISEASE

UNDERSTANDING THE PROBLEM

The liver is a large organ that sits on the right side of the belly. The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

Veno-occlusive disease of the liver, also known as sinusoidal obstruction syndrome (SOS), is blockage of the very small (microscopic) veins in the liver. Veno-occlusive disease is similar to Budd-Chiari syndrome except that blood flow is blocked only in very small blood vessels in the liver rather than in larger ones in the liver or in blood vessels outside the liver. That is, blockages do not affect the large hepatic veins and the inferior vena cava (the large vein that carries blood from the lower parts of the body, including the liver, to the heart).

Because flow out of the liver is blocked, blood backs up in the liver. This backup (congestion) then reduces the amount of blood entering the liver. Liver cells are damaged because they do not get enough blood (ischemia). The congestion causes the liver to become engorged and enlarged. The congestion also causes increased pressure in the portal vein (portal hypertension). Portal hypertension can result in dilated, twisted (varicose) veins in the esophagus (esophageal varices). The elevated pressure in the portal vein and the liver congestion lead to fluid accumulating in the abdomen—called ascites. The spleen also tends to enlarge. Such congestion reduces blood flow into the liver. The resulting liver damage leads eventually to severe scarring (cirrhosis).

UNDERSTANDING WHO SUFFERS

Veno-occlusive disease (VOD) may occur at any age; equally in males, females and children and has no racial predilection.

It is a rare but significant complication of allogeneic bone marrow transplantation (BMT). Along with GVHD and CMV infection, VOD is one of the most common serious complications after stem cell transplantation. Precise estimates of frequency are difficult because the incidence of veno-occlusive disease varies depending on the preparative regimen, the type of transplantation, and the underlying disease. The reported overall incidence of VOD ranges from 5% to more than 60% in children, and similar rates have been reported in adults.

Early identification of high-risk patients with severe disease is of the utmost importance because of the high mortality rates associated with severe veno-occlusive disease

Although blood and marrow transplants can save patients’ lives, they can also result in numerous complications, including infections, renal failure, and liver complications, such as veno-occlusive disease (VOD). VOD can occur in as high as 70% of patients and is the most common hepatic complication in the immediate post-transplant period. Along with infections and graft-versus-host disease, it is also one of the most common causes of death after transplant.

Other causes of VOD are:

  • Ingestion of pyrrolizidine alkaloids, which are found in crotalaria and senecio plants (used in Jamaica to make herbal tea) and in other herbs, such as comfrey.
  • Use of certain drugs that occasionally have toxic effects on the liver, including cyclophosphamide and azathioprine (used to suppress the immune system)
  • Radiation therapy (used to suppress the immune system before bone marrow or stem cell transplantation)
POTENTIAL SIGNS AND SYMPTOMS

Symptoms of VOD are not limited to the liver and may begin suddenly.

  • The liver enlarges and becomes tender.
  • The abdomen may swell because of fluid accumulating there.
  • The skin and the whites of the eyes may become yellow—a condition called jaundice.
  • Varicose veins in the esophagus may rupture and bleed, sometimes profusely, causing people to vomit blood and often go into shock.
  • The blood may pass through the digestive tract, making stools black, tarry, and foul-smelling (called melena).
  • A few people develop liver failure with deterioration of brain function (hepatic encephalopathy), resulting in confusion and coma.
  • Other people develop cirrhosis over time, usually over months, depending on the cause and repeated exposure to toxic agents.
EXAMINATIONS USUALLY REQUIRED

Doctors suspect veno-occlusive disease based on symptoms or blood test results that suggest liver dysfunction, particularly if people have ingested substances or have conditions that may cause the disease (particularly people who have had a bone marrow or stem cell transplant):

  • Blood tests, are undertaken to determine how well the liver is functioning and whether it is damaged (liver function tests) and to evaluate blood clotting
  • Doppler ultrasonography often confirms the diagnosis. Occasionally, invasive tests are necessary. These tests include liver biopsy or measurement of blood pressure in the hepatic veins and portal vein. To measure blood pressure in these veins, doctors insert a catheter into a vein in the neck (jugular vein) and thread it to the hepatic veins. A liver biopsy can be done at the same time.
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Liver Disorders

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery.

AIMIS is an expert in Robotic Surgery for Robotic Assisted Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections and other minimal invasive procedures for the Liver involving the best American and International surgeons who are experts in the field including:

  • Hepatic fibrosis and sclerosis - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Central haemorrhagic necrosis of liver - Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver
  • Infarction of liver - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Hepatic veno-occlusive disease - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Liver Cysts - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Focal nodular hyperplasia of liver - Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver

Explanation of Surgery Types:

  • Large Liver Resection – Right Lob Removed plus Segmentectomy (segment number 4)
  • Right Liver Lobectomy- Removal of one of the two lobes of liver
  • Left Liver Lobectomy - Removal of one of the two lobes of liver
  • Segmentectomy - Removal of one of the eight segments of liver
  • Multiple Segmentectomies – Two or More removal of the segments of Liver
  • Complex Segmentectomies –Complex removal of the segments of Liver
  • Small Resections – Removal of small parts of Liver ( smaller than Segments)
  • Wedge resection, non-Anatomical - Tumor removal with portion of liver
  • Left Lateral Sectionectomy- Removal of the Left Lateral Segment/section of the Liver
  • Two Step Liver Resection- Liver Regeneration

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Once VOD is diagnosed, it is classified according to severity.

  • Mild VOD: patients do not experience any harmful effects, and treatment is not necessary.
  • Moderate VOD: patients experience adverse effects such as abdominal pain. Treatment is necessary, but patients usually make a complete recovery.
  • Severe VOD: patients experience adverse effects caused by liver disease. If signs and lab values are not resolved within 100 days of transplant, severe VOD may be fatal.
FURTHER INFORMATION ON INCREASED RISK GROUPS

Several risk factors have been identified for the development of VOD. One of the main risk factors is pre-existing hepatic disease. This hepatic dysfunction may result from previous treatment including for example abdominal irradiation.

Research indicates that other causes of pre-existing hepatic disease including viral hepatitis or iron overload in patients with β thalassaemia major may also contribute to hepatic toxicity.

Stem cell source and choice of conditioning regimen also influence the risk of VOD. The risk of VOD is higher after allogeneic transplantation than after autologous transplantation and is also higher in patients who are receiving a second transplant. Underlying diagnosis and age also influence risk. Lower age has been associated with an increased risk of the condition.

FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Differential diagnosis may be made based on clinical signs and symptoms or blood test results that suggest liver dysfunction, particularly if people have ingested substances or have conditions that may cause the disease (particularly people who have had a bone marrow or stem cell transplant).

WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections and other minimal invasive procedures for the Liver involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for the Liver and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Less scarring
  • High patient satisfaction
  • Minimal pain
  • More precise removal of cancerous tissue
  • Less risk of converting to open surgery
  • Reduced risk of blood loss
  • Shorter hospital stay

The advantage of robotic surgery is the avoidance of large incision, and also helps in removing complex or critical tumors which are otherwise, very hard to do with tradition open surgery methods. As the liver is one of the highly regenerating organ of our body, by employing robotic surgery techniques, one can easily remove complex tumors with minimal discomfort without affecting its regenerating power. Robotic technology has also been successfully used in liver transplantation, which has made liver transplantation simpler with fewer complications.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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