title: Evaluation, operative management, and outcome after liver transplantation in children with biliary atresia and situs inversus.
abstract: BACKGROUND
  Biliary atresia, a common indication for liver transplantation, can be associated with situs inversus. Our experience with liver transplantation in children (n = 6) was reviewed retrospectively.
  
  
  METHODS
  Preoperative duplex sonography, computerized tomography, and visceral angiography were obtained. Vascular anomalies identified included preduodenal portal vein (6/6), interrupted inferior vena cava (5/6), and aberrant hepatic artery (4/6).
  
  
  RESULTS
  The liver graft was placed in a midline position. Venous continuity was achieved by donor suprahepatic inferior vena cava to recipient hepatic cloaca and direct end-to-end portal anastomosis. The donor infrahepatic inferior vena cava was oversewn. Arterial continuity was restored using either a direct branch-patch anastomosis (3/6) or a supraceliac aortic interposition graft (3/6). In retrospect, preoperative diagnostic work-up was noncontributory and outcome was not complicated by pre-existing situs inversus.
  
  
  CONCLUSIONS
  Situs inversus in liver recipients requires operative technical modifications, but does not change outcome. Furthermore, extensive preoperative work-up should be avoided.
authors.affiliation: Dumont UCLA Transplant Center, Department of Surgery, UCLA School of Medicine 90024, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Farmer
authors.forename: A
authors.initials: A
authors.lastname: Shaked
authors.forename: K M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: D K
authors.initials: DK
authors.lastname: Imagawa
authors.forename: J M
authors.initials: JM
authors.lastname: Millis
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D001656:Biliary Atresia / Q000150:complications / Q000601:surgery*; D002648:Child; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012857:Situs Inversus / Q000150:complications*; D016896:Treatment Outcome