title: One surgeon's experience with the piggyback versus the standard technique in orthotopic liver transplantation: is one better than the other?
abstract: OBJECTIVE
  Traditionally, orthotopic liver transplantation has consisted of a total native hepatectomy that included retrohepatic inferior vena cava. The so-called "piggyback" technique was described by Tzakis et al. (2). It consists of a recipient hepatectomy with preservation of the native retrohepatic IVC and subsequent anastomosis of the homograft suprahepatic IVC to a cuff fashioned from the recipient's suprahepatic veins. In this study, a single surgeon's experience with both techniques during the same period of time is discussed to analyze any significant differences in survival, intraoperative blood loss, length of stay in the ICU, and total length of stay in the hospital.
  
  
  METHODS
  Over a three year period, 128 patients were transplanted at the University of Pittsburgh. Of these, 66 patients (51.6%) had a piggyback (PB) operation while the remaining 62 (48.4%) had a "standard" (ST) operation.
  
  
  RESULTS
  The actual 6 month survival was 81.8% in the PB group (54/66) and 74.2% in the ST group (46/62), with no statistical difference between the two. The median intraoperative blood usage was 6 units for the PB group versus 10 units for the ST group (p > 0.02). The median ICU length of stay was the same at 4 days, as was the total hospitalization duration, 21 days. The in-hospital deaths were included in the analysis.
  
  
  CONCLUSIONS
  The piggyback technique has some advantages, including less bleeding and absence of brachial plexus or phrenic nerve injury. Several other important considerations are discussed. In conclusion, the results with the piggyback technique are equivalent to those obtained with the standard approach.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA., USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Stieber
mesh_terms: D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate