title: Omental flap for hepatic artery coverage during liver transplantation.
abstract: In 1994, a technique of omental flap interposition to cover the celiac and mesenteric vessels after pancreaticoduodenectomy was described. It aimed to isolate the pancreatic anastomosis from the vessels dissected during pancreaticoduodenectomy. In liver transplantation (LT), the omental flap was initially used to reduce the risk of hepatic artery (HA) kinking. Currently, we use this technique to cover the dissected HA, reducing the consequences of postoperative biliary fistula (BF), particularly the risk of postoperative complications (thrombosis/bleeding). We describe this technique adding a simple modification consisting of covering the HA with an omental flap after completion of the biliary anastomosis. We performed LT with an omental flap to cover the HA vessels in 62 (55 %) of the 112 consecutive patients who underwent LT between January 2012 and July 2013. No postoperative deaths occurred. The rate of BF was 9.7 % (six cases). In the omental flap series, no postoperative thrombosis, HA pseudoaneurysm, or complications occurred. In the six cases of BF, the dissected HAs were completely isolated from the biloma. This simple technique has no specific morbidity; it isolates the HA from the biliary anastomosis and therefore may reduce the risk of severe postoperative HA complications after LT.
authors.affiliation: Department of General and Liver/Pancreas Transplant Surgery, School of Medicine, Hôpital Saint Eloi, University of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France, f-panaro@chu-montpellier.fr.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Panaro
authors.forename: Hassan
authors.initials: H
authors.lastname: Bouyabrine
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Carabalona
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nougaret
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Georges Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.forename: Francis
authors.initials: F
authors.lastname: Navarro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000517:prevention & control; D013524:Surgical Flaps; D055815:Young Adult