title: Liver transplantation with piggyback anastomosis using a linear stapler: a case report.
abstract: The so-called piggyback technique of liver transplantation (PB-LT) preserves the recipient's caval vein, shortening the warm ischemic time. It can be reduced even further by using a linear stapler for the cavocaval anastomosis. Herein, we have presented a case of a patient undergoing a side-to-side, whole-organ PB-LT for cryptogenic cirrhosis. Upper and lower orifices of the donor caval vein were closed at the back table using a running 5-0 polypropylene suture. Three stay sutures were then placed on caudal parts of both the recipient and donor caval with a 5-mm venotomies. The endoscopic linear stapler was placed upward through the orifices and fired. A second stapler was placed more cranially and fired resulting in a 8-9 cm long cavocavostomy. Some loose clips were flushed away from the caval lumen. The caval anastomosis was performed within 4 minutes; the time needed to close the caval vein stapler insertion orifices (4-0 polypropylene running suture) before reperfusion was 1 minute. All other anastomoses were performed as typically sutured. The presented technique enables one to reduce the warm ischemic time, which can be of particular importance with marginal grafts.
authors.affiliation: Department of Surgery, Liver Transplantation Institute, Inonu University Faculty of Medicine, Malatya, Turkey. Elect akbulutsami@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Akbulut
authors.forename: M
authors.initials: M
authors.lastname: Wojcicki
authors.forename: C
authors.initials: C
authors.lastname: Kayaalp
authors.forename: S
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000714:Anastomosis, Surgical; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged