SLT is an effective surgical strategy to meet the demands in a combined adult and pediatric transplant center. Good outcomes can be achieved with a standardized technique.

This study showed a low risk of donor-recipient CPE transmission, indicating that donor CPE colonization does not necessarily represent a contraindication for donation unless colonization regards the organ to be transplanted. Donor and recipient screening remains essential to prevent CPE transmission and cross-infection in transplantation centres.

Plasma levels of coagulation factors differ profoundly between adults and children, but are remarkably stable throughout adulthood. It is unknown which factors determine plasma levels of coagulation factors in a given individual. We hypothesized that the liver, which synthesizes coagulation factors, also controls plasma levels. We measured a panel of coagulation factors in samples taken from either adults or young children who underwent a liver transplantation with adult donor livers. Samples were taken 1-3 months after transplantation, when the patients were clinically stable with adequate graft function. After liver transplantation, the hemostatic profile of the pediatric group was remarkably different from that of the adult group, and resembled the hemostatic profile of normal children. Thus, children transplanted with an adult liver graft maintain a pediatric hemostatic profile after transplantation despite receiving an adult liver graft. These findings suggest that plasma levels of hemostatic proteins are not controlled by the liver. IntroductionThe liver plays a central role in hemostasis because it synthesizes many of the plasma proteins involved in coagulation and fibrinolysis. 1 Although plasma levels of the various proteins vary between individuals, levels of these proteins within an individual are remarkably stable throughout adulthood, 2 although subtle elevations in coagulation factors are observed with increasing age. 3 In young children, the hemostatic system is still in development, and plasma levels of various hemostatic proteins in young children are profoundly different from that of adults. [4][5][6][7][8] Although levels of many coagulation factors increase toward values found in adults in the first year of life, striking differences between infants and adults are still present in children at 6 months of age. 6 More subtle differences between children and adults are still observed between the ages of 1 and 16 years. 4 It is not known which factors control the levels of coagulation factors in a given individual, but it appears plausible that the liver may be involved.Children with end-stage liver disease may undergo liver transplantation. These children will frequently obtain a split-liver graft from an adult donor. In these children undergoing transplantation, a unique situation occurs in which liver mass is not significantly different from children who do not, but liver tissue is of adult origin. Here we investigated whether transplantation of an adult (split) liver graft into very young children would convert the pediatric hemostatic status to a hemostatic profile similar to that of adults. Methods PatientsEleven children who underwent a primary (n ϭ 10) or second (n ϭ 1) liver transplantation for biliary atresia (n ϭ 10) or metabolic disease (n ϭ 1) with a mean of age 8.5 months (range, 4.2-11.7 months) and 9 adults with a mean age of 56 years (range, 46-65 years) who underwent transplantation for cirrhosis of various etiology (primary sclerosing cholangitis, 2 [one of which was a retrans...

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Introduction Trocar site hernia (TSH) is a complication of minimally invasive surgery that is often underestimated. These lesions cause patient discomfort and require surgery for their correction. Although there are some case reports for laparoscopic repair of TSH, there is data missing in the literature about this specific topic. The aim of this study is to evaluate safety and efficacy of the laparoscopic repair of TSH. Methods We collected data regarding 213 patients submitted to incisional hernia repair in the Department of General Surgery at Humanitas Mater Domini Clinical Institute in Italy since 2011 and 2019. We selected the patients submitted to laparoscopic repair of a TSH with an intraperitoenal mesh. We evaluated the clinical and surgical characteristics of the patients and the following outcomes: post-operative hospitalization, complications and long-term recurrences. Discussion Forty-two out of 213 patients were operated for a TSH. Forty out of 42 patients (95.2%) were treated with a laparoscopic approach. Follow up: 60 months. Study group: females (62.5%), mean BMI 29.1. According to EHS (European Hernia Society) classification, 35 patients had a midline defect. In 77.5% of cases a ePTFE/PP mesh was implanted. Mean hospitalization: 2 nights. The complication rate was low (1 surgical site infection, 1 seroma and 1 hematoma), without re-intervention. We observed 2 cases of recurrence (5%) developed after 5 months and 36 months, respectively. Conclusions Laparoscopic repair of TSH is a safe approach, in absence of specific contraindications. Our experience suggest that a laparoscopic approach could obtain satisfying results.