[Surgical techniques for vascular reconstruction of the portal vein and hepatic artery in living-donor liver transplantation].
To decide how to reconstruct the portal vein and hepatic artery for liver transplantation, anatomical variation, diameter, length, and injury to vessels during surgery, and the quality of recipient vessels should be considered. Hence, it is of key importance for donor and recipient surgeries to prepare adequate vessels for reconstruction. For reconstruction of the portal vein, anastomosis with as large a diameter as possible is required to obtain good portal flow. In cases with sclerosing stenosis and old thrombus, technical innovations such as branch-patch, a conduit using a vein graft, and venoplasty using a venous patch are necessary. For reconstruction of the hepatic artery, selecting a satisfactory recipient artery, overcoming size mismatch, and gentle handling of a recipient artery with pathological changes are important. Arteries smaller than 3 mm are anastomosed with a surgical microscope using the united suture technique. The fishmouth technique or funnelization technique can be used for anastomoses with a significant size mismatch, and an autoarterial graft is used when arteries do not reach each other.
Egawa
H
H
Department of Transplantation Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan.
Asonuma
K
K
Sakamoto
Y
Y
Iwasaki
M
M
Kim
I
I
Tanaka
K
K
D000714:Anastomosis, Surgical / Q000379:methods; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*