C Karaca1, C Yilmaz2, R Ferecov2, Z Iakobadze2, K Kilic2, L Caglayan2, S Aydogdu3, M Kilic4. 1. Department of General Surgery, Izmir University of Economics, Faculty of Medicine, Izmir, Turkey. 2. Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey. 3. Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey. 4. Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey. Electronic address: murat.kilic@kenthospital.com.
Abstract
BACKGROUND: Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients. METHODS: Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed. RESULTS: Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient. CONCLUSIONS: Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors.
BACKGROUND: Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients. METHODS: Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed. RESULTS: Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient. CONCLUSIONS: Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors.
Authors: V Gunasekaran; M S Reddy; A Rammohan; N Shanmugam; D Thiruchunapalli; R G Kanagavelu; I Kaliamoorthy; M Rela Journal: World J Surg Date: 2022-09-07 Impact factor: 3.282