title: Extensive Adhesions in Living Donor Liver Transplantation: A Retrospective Analysis.
abstract: BACKGROUND
  Adhesions are abnormal fibrous bands of scar tissue between internal organs and tissues. With respect to recipient hepatectomy in living donor liver transplantation (LDLT), we defined extensive adhesions as adhesions in at least two separate locations that required more than 5 % of the total surgical time to lyse. We aimed to identify the etiology and consequences of this preventable burden.
  
  
  METHODS
  A simple retrospective case-control study of all cases with extensive adhesions from August 2011 to September 2014 matched by age, sex, and diagnosis at surgery.
  
  
  RESULTS
  A total of 380 cases were studied. Thirty-eight and five patients had extensive adhesions from surgical and non-surgical causes, respectively. The incidence and complications in pediatric patients were far less than in adults. In the adult group, the mean operative time was increased by 75 min (12.3 %) and blood loss by 2.5 L.The incidence of bowel perforation and biliary infections were increased in adults, while there was no significant difference in the rate of ascitic or wound infections. The 1-year survival was slightly less (92 %) than the control group (100 %).
  
  
  CONCLUSIONS
  The most common cause of extensive adhesions at LDLT was prior liver resection. Extensive adhesions caused increased morbidity by increased blood loss, transfusion requirements, and increased cold ischemia time. There is also a higher risk of bowel perforation during enterolysis. The use of commercially available barrier techniques is advisable in adults at high risk of developing adhesions with a possibility of liver transplantation, such as liver resection for HCC.
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Hirak
authors.initials: H
authors.lastname: Pahari
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Li
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan. ufel4996@ms26.hinet.net.|Department of Surgery, Chang Gung Memorial Hospital Chiayi, Chang Gung University College of Medicine, Taoyuan City, Taiwan. ufel4996@ms26.hinet.net.
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Ting-Lung
authors.initials: TL
authors.lastname: Lin
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.affiliation: Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000328:Adult; D000367:Age Factors; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D016022:Case-Control Studies; D002648:Child; D050377:Cold Ischemia; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D016031:Liver Transplantation; D019520:Living Donors; D061646:Operative Time; D012189:Retrospective Studies; D015996:Survival Rate; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome