ABSTRACT
Re-transplantation operation is a technically difficult procedure because of many adhesions; it has higher morbidity and mortality. In this article a maneuver facilitating liver re-transplantation is described. 27-year old male with hepatic artery thrombosis three months after the deceased liver transplantation admitted to our clinic for retransplantation. Related living right lobe liver transplantation was planned. During recipient’s hepatectomy, the hepatic hilum was transected first, but retroperitoneal dissection and identification of the patient’s vena cava was very difficult. Prolonged operative time and risk of mesenteric venous hypertension after the clamping of portal vein required an application of temporary porto-caval bypass. For this shunt the portal vein of recipient and lower end of cadaveric liver vena cava (“piggyback vena cava”) were used. Vena cava of patient was not clamped during the bypass application, so blood flow in patient’s inferior vena cava was not deteriorated. The liver was removed with both caval veins (cadaveric liver vein and recipient’s own vein) remained in patient’s body. Living donor graft was connected to the piggyback vena cava. Temporary shunt was divided and portal vein anastomosed to the graft portal vein. Arterial anastomosis was performed with recipient’s gastroepiploic artery and the biliary reconstruction fashioned by Roux-en-Y hepaticojejunostomy. So, piggyback vena cava can be used successfully and safely for temporary porto-caval shunt during the liver retransplantation.
ABSTRACT
BACKGROUND AND AIM: Biliary fistulas are the most common morbidity (8.2-26 percent) following hydatid liver surgery. The aim of our study was to reduce the incidence of postoperative biliary fistulas after the suturing of cystobiliary communications by applying a bile leakage test. PATIENTS AND METHODS: A total of 133 hydatid liver cysts from 93 patients were divided into two groups, according to whether the test was performed. Tests were performed on 56 cysts from 34 patients, and the remaining 77 cysts from 59 patients were treated without the test. In both groups, all visible biliary orifices in the cysts were suture ligated, and drains were placed in all cysts. The visibility of the biliary orifices and postoperative biliary drainage through the drains were recorded. Patients in both groups were also compared with respect to the number of days living with the drains, the length of the hospital stay, and secondary interventions related to biliary complications. RESULTS: Biliary orifices were more visible in the tested cysts (13 percent vs. 48 percent; P <0.001). Fewer biliary complications occurred in the tested patients (8.8 percent vs. 27.7 percent, P = 0.033). The mean drain removal time (4.1±3.3 days vs. 6.8±8.9 days, P<0.05) and the length of the hospital stay (6.7±2.7 days vs. 9.7±6.3 days, P,0.01) were shorter for the tested patients. None of the patients in the test group required postoperative Endoscopic retrograde cholangiopancreaticography (ERCP) or nasobiliary drainage (0.0 percent vs. 8.4 percent, P = 0.09). There were no long-term biliary complications for either group after three years of follow-up. CONCLUSIONS: Identification of biliary orifices with a bile leakage test and the suturing of cystobiliary communications significantly reduced postoperative biliary complications following hydatid liver surgery.