Technical modification of reno-portal anastomosis in living donor liver transplantation for patients with obliterated portal vein and large spontaneous splenorenal shunts.
OBJECTIVE
End-stage liver disease patients with obliterated portal vein(PV) and large spontaneous splenorenal shunts (SRS) are often indicated to renoportal bypass as a reconstruction of portal inflow during liver transplantation. The aim of this study was to show the feasibility and safety of the side-to-end (S-to-E) renoportal anastomosis (RP-A).


METHODS
RP-A were performed in 5 patients among 597 adult living donor liver transplantation (LDLT) with end-to-end (E-to-E) or S-to-E method interposing cadaveric fresh vessel grafts between left renal vein (LRV) and PV of liver graft from October 2005 to June 2008.


RESULTS
One patient underwent E-to-E RP-A, but it was technically difficult in our experience because of thin and retracted renal vein end under poor operation field. Remaining four patients underwent side-to-end (S-to-E) RP-A which allowed us to perform easy and secure anastomosis under better and more stable operation field, because LRV continuity with vena cava was preserved without retraction of anastomosis site. Except one patient having two left-lobes dual-graft LDLT who died from cerebral hemorrhage, four patients were recovered well with normal graft function and a patent RP-A.


CONCLUSIONS
S-to-E anastomosis is technically more feasible and easier method than E-to-E anastomosis for RP-A interposing cadaveric fresh vessel in LDLT.
Moon
Deok-Bog
DB
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Ahn
Chul-Soo
CS
Kim
Ki-Hun
KH
Hwang
Shin
S
Ha
Tae-Yong
TY
Song
Gi-Won
GW
Jung
Dong-Hwan
DH
Ryu
Je-Ho
JH
Kim
Kwan-Woo
KW
Choi
Nam-Kyu
NK
Ko
GiYoung
G
Sung
KyuBo
K
Lee
SungKoo
S
D000328:Adult; D001011:Aorta / Q000637:transplantation; D001163:Arteriovenous Anastomosis; D005260:Female; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012079:Renal Circulation; D012082:Renal Veins / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior / Q000637:transplantation