title: Recanalized umbilico-caval anastomosis as a temporary portosystemic shunt in pediatric living donor liver transplantation: the crossed fingers method.
abstract: A temporary portocaval shunt (TPCS) associated with retrohepatic vena cava preservation prevents the edema caused by splanchnic congestion during liver transplantation (LT), especially for non-cirrhotic cases. We herein report a modified TPCS technique using the recanalized umbilical vein and an end-to-side recanalized umbilico-caval anastomosis for use during pediatric living donor liver transplantation (LDLT). This work evaluated a group of pediatric patients who underwent LDLT between 2001 and 2014 with the conventional TPCS (n=16) vs the recanalized umbilico-caval shunt (the crossed fingers method, n=10). The crossed fingers method was performed by suturing an end-to-side anastomosis of the patent or recanalized umbilical vein to the vena cava using a continuous monofilament suture like "crossing the fingers," that is, placing the left portal vein across the portal vein trunk next to it. The preoperative, surgical, and postoperative characteristics were similar in both groups except for the significantly shorter portal vein clamping time for the crossed fingers method. This method can allow the portal circulation to be totally decompressed before and after implanting the graft and while maintaining the hemodynamic stability throughout all stages of pediatric LDLT.
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan. turahashi@jichi.ac.jp.
authors: Taizen
authors: T
authors: Urahashi
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Yoshiyuki
authors: Y
authors: Ihara
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Yukihiro
authors: Y
authors: Sanada
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Noriki
authors: N
authors: Okada
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Naoya
authors: N
authors: Yamada
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Yuta
authors: Y
authors: Hirata
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Takumi
authors: T
authors: Katano
authors: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
authors: Koichi
authors: K
authors: Mizuta
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D017063:Outcome Assessment, Health Care; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011183:Postoperative Complications; D014471:Umbilical Veins / Q000601:surgery*
keywords: liver transplantation; pediatric living donor liver transplantation; round ligament; temporary portocaval shunt; umbilical vein