title: Extracorporeal suture technique for suprahepatic caval anastomosis in liver transplantation.
abstract: BACKGROUND
  During liver transplantation, an oversized graft or active bleeding in the hepatic area can make performance of the suprahepatic caval anastomosis extremely difficult or even impossible. In other instances, a brief as possible warm ischemia is desired to provide a marginal graft with maximum chances of good functioning.
  
  
  METHODS
  In order to manage those conditions, a suture technique was devised that allows the construction of a substantial part of the suprahepatic caval anastomosis keeping the graft outside the abdomen of the recipient.
  
  
  RESULTS
  Over a 12-month period, the technique was applied in 7 out of 148 transplants (5%). The 7 cases presented one or more of the following conditions: significant oversize mismatch (n = 6), active bleeding in the hepatic area (n = 1), and marginal graft (n = 4). Warm ischemia time averaged 27 minutes, a value not significantly different from the mean warm ischemia time of 25 minutes recorded in the easier transplants in which the conventional technique was used (P = 0.2467).
  
  
  CONCLUSIONS
  This extracorporeal suture technique allows construction of the suprahepatic caval anastomosis in critical situations arising during liver transplantation and avoidance of the prolonged warm ischemia that could be expected in such cases.
authors.affiliation: Liver Transplantation Center, San Giovanni Battista Hospital, Corso Bramante 88, 10126 Turin, Italy. msalizzoni@molinette.piemonte.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.forename: Fausto
authors.initials: F
authors.lastname: Zamboni
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D013536:Suture Techniques; D016896:Treatment Outcome; D014684:Venae Cavae / Q000601:surgery*