title: Management of hemorrhage of retro hepatic inferior vena cava injury during piggy-back technique for liver transplantation.
abstract: BACKGROUND
  Injury to large abdominal vessels is still one of the most terrifying results of trauma or intraoperative faults, as the management of the hemorrhage is hardly difficult due to being torrentially and unaware of the proper reparation. The controversial problem is which technique should be preferred in case of injury to RHIVC and how can it be managed with minimal risk.
  
  
  METHODS
  Over two-year period, we retrospectively analyzed the patients who had undergone adult-to-adult liver transplantation and collected data about the injuries to RHIVC during recipient hepatectomy. All patients were treated with the same surgical technique including digital compression and continuous suturing the tear.
  
  
  RESULTS
  Twenty five patients (21 male, 4 female) were detected. The causative factors for end stage liver disease included hepatitis B, hepatitis C with or without hepatocellular carcinoma, autoimmune hepatitis, alcoholic hepatitis, cryptogenic hepatitis, Wilson disease, and nonalcoholic steatohepatitis. Mean diameter of the injury was measured 0.5 cm (range: 0.2-1.6). Only three patients (12%) had more than one injury. Mean amount of blood loss between injury and repair was 130 cc (40-350 cc). There was no operative mortality.
  
  
  CONCLUSIONS
  Calmness of the operative team followed by the appropriate surgical approach is the key of the success in case of any injury to RHIVC. Digital compression technique can be enough to prevent massive bleeding and repair the injury tract without any vascular exclusion that may result with serious postoperative complications. We proposed this technique because of its ability by most surgeon and easy to perform in a safe way.
authors.affiliation: Organ Transplantation and Research Center, Ege University School of Medicine, Izmir, 35100 Turkey.
authors.forename: Aydin
authors.initials: A
authors.lastname: Unal
authors.forename: Yazici
authors.initials: Y
authors.lastname: Pinar
authors.forename: Zeytunlu
authors.initials: Z
authors.lastname: Murat
authors.forename: Kilic
authors.initials: K
authors.lastname: Murat
keywords: Approach to vena cava injury; Digital compression; Retrohepatic inferior vena cava; Surgical technique