Microsurgical reconstruction of the hepatic and superior mesenteric arteries using a back wall technique.

During the last seven years, 17 patients underwent microsurgical reconstruction of 14 hepatic and four superior mesenteric arterial systems following extended pancreatectomy or hepatectomy, and in living-related liver transplantations (LRLT). All microvascular anastomoses in this series were performed using a back wall technique, in which the microsutures are placed in the back wall of the vessel first, and turning over of the microclamp is eliminated. This back wall technique is useful for microvascular reconstruction in a deep abdominal cavity in which there is no room to turn over the microclamp. In LRLTs, even if the hepatic artery of the graft liver is so short that the microclamp on it cannot be rotated, this technique overcomes such difficult situations. Microvascular anastomosis without turning over the clamp is superior to the conventional method in terms of reducing intimal damage to the vessels. The vessels located vertical to the microvascular surgeon are smoothly anastomosed using this technique. The authors advocate this back wall technique as advantageous in microsurgical reconstructions of the hepatic and superior mesenteric arterial systems.