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ORIGINAL ARTICLE
Year : 2017  |  Volume : 36  |  Issue : 4  |  Page : 424-431

Management of difficult hepatic artery anastomosis in living donor liver transplantation: mansoura experience


General Surgery Department, Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt

Correspondence Address:
Ayman El Nakeeb
General Surgery Department, Gastroenterology Surgical Center, Mansoura University, Mansoura 35516
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_73_17

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Background One of the most difficult and important procedure in living donor liver transplantation (LDLT) is hepatic artery reconstruction. Difficult hepatic artery reconstruction may be because of pathological factor such as intimal dissection (ID) and anatomical variation. Difficult hepatic artery reconstruction is a risk factor for hepatic artery complications. This study was done to evaluate difficult hepatic artery reconstruction in LDLT at our center and its surgical outcomes. Patient and methods Consecutive patients who were treated for end-stage liver cirrhosis by LDLT were retrospectively reviewed. The management of hepatic artery with ID is carried out according to the extent of ID. Results Hepatic artery ID was found in 21/375 (5.6%) cases. Overall, seven (33%) cases were reconstructed with the graft hepatic artery after trimming the edge until reaching a healthy segment. A total of 11 (52.4%) cases were reconstructed with the graft hepatic artery after intimal fixation of ID. Moreover, three (14.3%) cases had severe ID and failed intimal fixation and were reconstructed with the recipient splenic artery. Biliary stricture developed in two patients who had severe ID, and three patients developed transient bile leak. No hepatic artery complications, graft failure, or mortality occurred. Conclusion Intimal fixation technique proved to be an effective technique in most of the cases, with good short-term and long-term follow-up results. In severe ID or failure of intimal fixation, alternative recipient arteries other than hepatic artery can be used.


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