Portoumbilical anastomosis as a simple method of transient portosystemic shunt during liver transplantation.
BACKGROUND
This article describes a new method of transient intraoperative portosystemic shunting, Splachnic edema after portal cross-clamping can be a dangerous complication during the anhepatic phase of the liver transplant operation. The current method seeks to avoid this problem, without the use of external venovenous bypass pump, by a temporary portocaval shunt, with retrohepatic cava preservation as first described experimentally in dogs by Fonkalsrud et al in 1966.


RESULTS
Among 227 liver transplant operations, we utilized a transient portosystemic shunt in 29 cases. The indication to perform a temporary shunt in all cases was the development of splachnic edema. In 3 instances, we performed a portoumbilical anastomosis using a prominent umbilical vein. The other 26 procedures employed the usual portocaval shunts. In these cases, splachnic congestion and onset of edema developed after cross-clamping of the round ligament and the portal vein, which resolved after the portoumbilical anastomosis.


CONCLUSIONS
The flow in the shunt was in all cases greater than 1 L/min. The most important risk factor for the development of splachnic edema was the presence of a patent umbilical vein, which occurred in 34.5% of shunted patients.


CONCLUSIONS
The use of a patent umbilical vein to perform a portoumbilical shunt was an effective, easy method to decompress the splachnic area, avoiding dangerous congestion and edema.
González-Pinto
I M
IM
Hospital Universitario Central de Asturias, Celestino Villamil, Oviedo Spain. igpinto@hotmail.com
Miyar
A
A
García-Bernardo
C
C
Vázquez
L
L
Barneo
L
L
Cortés
E
E
Díaz
P
P
Arias
D
D
Moreno
M
M
Granero
P
P
D000714:Anastomosis, Surgical / Q000379:methods*; D004487:Edema / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D011167:Portacaval Shunt, Surgical / Q000379:methods; D011169:Portal Vein / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014471:Umbilical Veins / Q000601:surgery*