title: Surgical rationalization of living donor liver transplantation by abolition of hepatic artery reconstruction under a fixed microscope.
abstract: The small diameter of the hepatic artery is one of the complexities of living donor liver transplantation (LDLT). We analyzed whether the direct suture technique using surgical loupes can simplify the operative process for LDLT compared with fixed microscopic reconstruction. We applied the direct technique to rationalize the operative process and abolished routine microsurgery from 2004. Two hundred and nine LDLT with a postoperative period over 34 months were carried out from 1996 to 2008. The patients were divided into two groups: the micro group (children: 20, adults: 72) and the non-micro group (children: 12, adults: 97). Running anastomosis was undertaken in the non-micro group. The anastomotic size of the children was significantly smaller than that of the adults, but larger than 2 mm (2.38±0.4 vs. 2.7±0.47 mm, p=0.0005). By appropriate choice of the proximal artery, direct anastomosis is possible even in children. Early complications occurred in seven cases in the micro group, but none occurred in the non-micro group (p<0.05). Significant reductions were observed in operation time (p<0.0001), blood loss (p<0.05), and hospital stay (p<0.01) in the non-micro group. Non-microscopic anastomosis is useful for the rationalization of LDLT.
authors.affiliation: Department of Gastroenterological, Transplant Surgery and Surgical Oncology, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan. twin1957yagi2000@yahoo.co.jp
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
authors.forename: Susumu
authors.initials: S
authors.lastname: Shinoura
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Umeda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sato
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Yoshida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshida
authors.forename: Masashi
authors.initials: M
authors.lastname: Utsumi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nobuoka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sadamori
authors.forename: Toshiyoshi
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D013536:Suture Techniques; D014656:Vascular Surgical Procedures