title: Splitting livers: Trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes.
abstract: Controversy remains about the best line of division for liver splitting, through Segment IV or through the umbilical fissure. Both techniques are currently used, with the choice varying between surgical teams in the absence of an evidence-based choice. We conducted a single-center retrospective analysis of 47 left split liver grafts that were procured with two different division techniques: "classical" (N = 28, Group A) or through the umbilical fissure and plate (N = 19, Group B). The allocation of recipients to each group was at random; a single transplant team performed all transplantations. Demographics, characteristics, technical aspects, and outcomes were similar in both groups. The grafts in Group A, prepared with the classical technique, were procured more often with a single BD orifice compared with the grafts in Group B; however, this was not associated with a higher incidence of biliary problems in this series of transplants (96% actual graft survival rate [median ± s.d.
  
  
  RESULTS
  26 ± 20 months]). Both techniques provide good quality split grafts and an excellent outcome; surgical expertise with a given technique is more relevant than the technique itself. The classical technique, however, seems to be more flexible in various ways, and surgeons may find it to be preferable.
authors.affiliation: Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.|Pediatric Surgery Chair, Università di Roma Tor Vergata, Rome, Italy.
authors.forename: J
authors.initials: J
authors.lastname: de Ville de Goyet
authors.affiliation: Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: di Francesco
authors.affiliation: Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Sottani
authors.affiliation: Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Grimaldi
authors.affiliation: Telemedicine Unit, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: A E
authors.initials: AE
authors.lastname: Tozzi
authors.affiliation: Hepato-Biliary Radiological Unit, Department of Imaging, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Monti
authors.affiliation: Liver Transplantation and HPB Surgery, Queen Elizabeth Hospital NHS, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Muiesan
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D009927:Tissue and Organ Procurement; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery
keywords: complications of liver transplantation; donor hepatectomy; pediatric liver transplantation; practice guidelines