Technical refinement of prosthetic vascular graft anastomosis to recipient inferior vena cava for secure middle hepatic vein reconstruction in living donor liver transplantation

I-Ji Jeong; Shin Hwang; Tae-Yong Ha; Gi-Won Song; Dong-Hwan Jung; Gil-Chun Park; Chul-Soo Ahn; Deok-Bog Moon; Ki-Hun Kim; Young-In Yoon; Sung-Gyu Lee

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자료유형: 학술저널

저자정보: I-Ji Jeong (University of Ulsan College of Medicine) Shin Hwang (University of Ulsan College of Medicine) Tae-Yong Ha (University of Ulsan College of Medicine) Gi-Won Song (University of Ulsan College of Medicine) Dong-Hwan Jung (University of Ulsan College of Medicine) Gil-Chun Park (University of Ulsan College of Medicine) Chul-Soo Ahn (University of Ulsan College of Medicine) Deok-Bog Moon (University of Ulsan College of Medicine) Ki-Hun Kim (University of Ulsan College of Medicine) Young-In Yoon (University of Ulsan College of Medicine) Sung-Gyu Lee (University of Ulsan College of Medicine)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제24권 제2호

발행연도: 2020.5

수록면: 144 - 149 (6page)

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Backgrounds/Aims: Hemashield vascular grafts has been used for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT). We occasionally encounter outflow disturbance of MHV conduit at the anastomotic stump of the middle-left hepatic vein (MLHV) trunk. To mitigate the disturbance, we carried out a series of studies regarding hemodynamics-compliant MHV reconstruction. Methods: This study comprised of three parts: Part 1: Determining the causes of outflow disturbance; Part 2: Computational simulative analysis; and, Part 3: Clinical application of our refined technique. The types of Hemashield conduit-MLHV stump reconstruction were end-to-end anastomosis (type 1), side-toend anastomosis (type 2), and oblique cutting of the conduit end and patch plasty (type 3). Results: In Part 1 study, the reconstruction types were type 1 in 23, type 2 in 25, and type 3 in 2. Significant anastomotic stenosis was identified in 7 (30.4%) in type 1, 6 (24.0%) in type 2, and none (0%) in type 3. The size of MLHV stump was the most important factor for anastomotic stenosis. Through Part 2 study, technical knacks were developed as follows: the conduit end was cut in a dumb-bell shape and a vessel patch attached; and then sutured bidirectionally from the 9 o’clock direction. In Part 3 study, these knacks were applied to 5 patients and none of them experienced noticeable anastomotic stenosis. Conclusions: Our refined technique to perform conduit-MLHV stump anastomosis appears to reduce the risk of anastomotic outflow disturbance for relatively small MLHV stump.

#Prosthetic vascular graft #Middle hepatic vein #Anastomosis #Hepatic venous congestion #Living donor liver transplantation

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