The new method of time-lag ligation for portosystemic shunt using coronary artery bypass graft occluder for adult living donor liver transplantation.
We performed a living donor liver transplantation (LDLT) for a 57-year-old man who had end-stage liver failure with portal hypertension and an inferior mesenteric vein-left testicular vein (IMV-LTV) shunt. At operation, we did not clamp the shunt but encircled it with a coronary artery bypass graft (CABG) occluder (Sumitomo Bakelite K.K., Japan), which was passed outside the body through the abdominal wall to time-lag ligation (TLL). On postoperative day (POD) 5, we observed decreased portal flow. We performed TLL of the shunt using the CABG occluder without re-laparotomy. The portal flow increased, while the portal vein pressure increased slightly. In LDLT, portosystemic shunt has been reported to be a cause of portal thrombus formation or graft liver atrophy due to decreased PV flow in the mid postoperative period. However, perioperative ligation of a portosystemic shunt may prevent regeneration of the grafted liver because of excessive portal hypertension. Therefore the technique of time-lag ligation of a portosystemic shunt using a CABG occluder may be a minimally invasive, useful method to achieve physiological liver graft regeneration.
Kokai
H
H
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, I-754 Asahimachi-Dori, Niigata 951-8510, Japan. kokain@med.niigata-u.ac.jp
Sato
Y
Y
Yamamoto
S
S
Oya
H
H
Nakatsuka
H
H
Kobayashi
T
T
Watanabe
T
T
Takizawa
K
K
Hatakeyama
K
K
D000328:Adult; D001026:Coronary Artery Bypass / Q000379:methods*; D006498:Hepatectomy; D019694:Hepatitis B, Chronic / Q000601:surgery*; D006801:Humans; D007565:Jaundice / Q000209:etiology / Q000821:virology; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012008:Recurrence; D055989:Septal Occluder Device / Q000706:statistics & numerical data; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome