title: A comparative study of the classic and piggyback techniques for orthotopic liver transplantation.
abstract: BACKGROUND
  The classic technique of hepatectomy with venovenous bypass may cause a longer anhepatic phase and increase the rate of some complications, such as post-operative renal failure and thromboembolic events. But, in some cases, such as tumors and anatomic difficulties, the surgeon is obligated to use the classic technique even though there is some controversy about the safety of this technique without venovenous bypass in liver transplantation. The aim of this study was to compare the results of using the classic technique without venovenous bypass and the piggyback technique for liver transplantation.
  
  
  METHODS
  A retrospective case-series study was conducted on 227 consecutive successful liver transplants, including 55 cases in which the classic technique was used and 172 cases in which the piggyback technique was used. The transplants were performed from March 2010 through June 2011 in the Visceral Transplantation Ward at Namazi Hospital in Shiraz, Iran. The piggyback method was the preferred approach for hepatectomy, but the classic technique without venovenous bypass was performed in cirrhotic cases with anatomic difficulties, when there was a tumor, or when the surgeon preferred it.
  
  
  RESULTS
  There were no significant differences in post-operative rise in creatinine, decreases in intraoperative blood pressure, transfused packed red blood cells (RBC), or survival rates between the groups. Warm ischemic time (duration that donor liver is out of ice until it's blood reperfusion in the recipient) was approximately seven minutes longer in the classic group (P = 0), but it was less than 52 minutes, which is an acceptable time for this phase. Hospital stays were shorter in the classic group than in the piggyback group (P = 0.024).
  
  
  CONCLUSIONS
  Although the piggyback technique is the preferred technique for hepatectomy in liver transplantation, the classic technique without venovenous bypass can be used safely in cirrhotic livers when necessary or if the physician prefers it.
authors.affiliation: Assistant Professor, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Saman
authors.initials: S
authors.lastname: Nikeghbalian
authors.affiliation: Fellowship of Visceral Transplantation, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad Naser
authors.initials: MN
authors.lastname: Toutouni
authors.affiliation: Professor, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Heshmatollah
authors.initials: H
authors.lastname: Salahi
authors.affiliation: Assistant Professor, Unit of Surgical Oncology Research, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Aliakbarian
authors.affiliation: Professor, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Malekhosseini
keywords: classic technique; liver transplantation; piggyback technique; venovenous bypass