Clearing Steatosis Prior to Liver Surgery for Colorectal Metastasis: A Narrative Review and Case Illustration

Over the recent years, non-alcoholic fatty liver disease (NAFLD) has become the most common liver disorder in the developed world, accounting for 20% to 46% of liver abnormalities. Steatosis is the hallmark of NAFLD and is recognized as an important risk factor for complication and death after general surgery, and even more so after liver resection. Similarly, liver steatosis also impacts the safety of live liver donation and transplantation. We aim to review surgical outcomes after liver resection for colorectal-metastases in patients with steatosis, and discuss the most common pre-operative strategies to reduce steatosis. Finally, as illustration, we report the favourable effect of a low-caloric, hyper-protein diet during a two-stage liver resection for colorectal metastases in a patient with severe steatosis.

Decrease in Incidence of PONV by using Ondansetron as Preemptive Antiemetic Agent in Liver Donors

Objective: To determine the role of preemptive ondansetron in reducing the incidence of post-operative nausea and vomiting in liver donors. Design of the Study: It was a randomized controlled trial. Study Settings: This study was carried out at Department of Anaesthesia and Hepatobiliary Unit, Sheikh Zayed Hospital Lahore from August 2017 to August 2019. Material and Methods: The study involved 100 male and female patients undergoing surgery for liver donation. These patients were randomly allocated into two arms. Subjects in the experimental group received a single pre-emptive dose of ondansetron before surgery. Outcome variable was incidence of post-operative nausea and vomiting as compared to controls. A written informed consent was obtained from every patient. Results of the Study: The mean age of the patients was 34.8±9.4 years. We observed a male predominance among these patients with male to female ratio of 1.9:1. The frequency of post-operative nausea (18.0% vs. 36.0%; p-value=0.043) and vomiting (6.0% vs. 24.0%; p-value=0.012) was significantly lower in patients receiving pre-emptive ondansetron. Conclusion: Preemptive administration of ondansetron substantially reduced the incidence of post-operative nausea and vomiting in patients undergoing surgery for liver donation which advocates preferred use of prophylactic ondansetron among such patients in future practice of donor liver transplant anaesthesia. Keywords: Liver Donors, Post-Operative Nausea, Post-Operative Vomiting, Ondansetron