title: Liver transplantation for iatrogenic porta hepatis transection.
abstract: Iatrogenic porta hepatis transection is a rare but devastating surgical complication. There are no systematic studies examining the best treatment strategy in patients with this injury. We report two cases of transection of all three portal structures, one during an open right adrenalectomy and another during a laparoscopic cholecystectomy, both of which were transferred to our tertiary care center hours postinjury. Diagnostic imaging and exploration revealed nonsalvageable livers, and both patients underwent total hepatectomies and portocaval shunting. Donor livers were available 12 to 20 hours after United Network for Organ Sharing Status 1 listing and both patients survived their postoperative course with 2- and 6-year follow up to date. Two-stage total hepatectomy with portocaval shunting followed by liver transplantation should be considered for patients presenting with porta hepatis transection.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2730, USA. vic.zaydfudim@vanderbilt.edu
authors.forename: Victor
authors.initials: V
authors.lastname: Zaydfudim
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Wright
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D041881:Cholecystitis, Acute / Q000601:surgery; D003135:Common Bile Duct / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D010673:Pheochromocytoma / Q000601:surgery; D011169:Portal Vein / Q000293:injuries*