Recipient hepatic artery intimal dissection (HAD) followed by hepatic artery thrombosis (HAT) is a serious complication of liver transplantation. Once this is recognized intraoperatively, the accepted approach is to use an alternative arterial inflow, which may not be possible in all patients. We describe a new classification and technique for the management of HAD during living donor liver transplantation. On the basis of the longitudinal extent of intimal dissection, HAD was classified into 4 types. Management was based on the type of dissection, availability of an adequate length of hepatic artery (HA), and an alternate source of inflow. The dissected HA itself was used for arterial anastomosis in patients with preserved pulsatile flow in the dissected artery and a lack of an alternative source of arterial inflow. The technique of using the dissected artery was based on close approximation of the tunica intima to the media with the first 2 sutures of the arterial anastomosis. Of 47 (2.4%) patients who developed HAD, 22 (46.8%) had a type 2 dissection for whom the other (right or the left) undissected HA was used for the anastomosis, and 20 (42.6%) had major (type 3 or 4) dissection. The dissected artery was used for the anastomosis in 9 (45%) of these patients. Postoperative HAT developed in only 1 of 9 patients. Pre-existing portal vein thrombosis and prior transarterial embolization were found to be major risk factors for the development of HAD. Using the technique described, the dissected artery can be successfully used for a satisfactory HA anastomosis with low thrombosis rates.

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Background: Natural portosystemic shunt ligation practices in liver transplant vary widely across transplant centres and are frequently undertaken to prevent the serious consequence of portal steal phenomenon. No concrete indications have so far been convincingly identified for their management in living donor liver transplant. Methods: We retrospectively studied the outcome of 89 cirrhotic patients who either did (n = 63) or did not (n = 25) undergo shunt ligation during living donor liver transplantation between 2017 and 2020. Results: The incidence of early allograft dysfunction/nonfunction (P = 1.0) and portal venous complications (P = 0.555) were similar between the two groups. Although overall complications, biliary complications, and the composite of Grade III and IV complications were significantly higher in the nonligated group (P = 0.015, 0.052 and 0.035), 1year graft and patient survival were comparable between them (P = 0.524). Conclusion: We conclude that shunt ligation in living donor liver transplantation may not always be necessary if adequate portal flow, good vascular reconstruction, and good graft quality have been ensured. ( J CLIN EXP HEPATOL xxxx;xxx:xxx)

Background: Intestinal obstruction continues to be a common surgical emergency throughout the world and its management protocol has evolved over years.  In our study we aimed to provide a complete epidemiological description of intestinal obstruction in adult age group patients in a tertiary care hospital in Northern India.Methods: This is a prospective study of patients belonging to age group more than 12 years admitted in our unit with clinical features suggestive of intestinal obstruction from September 2011 to December 2013 at R. N. T. Medical College, Udaipur. The study comprised of 134 patients.Results: Intestinal obstruction contributed to 6.5% of all surgical admissions. It was nearly twice more common in males. 43% patients presented with features of acute intestinal obstruction in comparison to 57% who presented with features of sub-acute intestinal obstruction. Most common cause observed was obstruction due to intra-abdominal adhesions followed by abdominal tuberculosis 48 and 29 percent respectively. Features of intestinal obstruction resolved in 60% patients with conservative management. Adhesions, abdominal tuberculosis and malignancy counted for majority of patients with sub-acute obstruction.  Emergency surgery was done in 32% of patients and 36.5 % of patients were discharged non-operatively. Planned Surgery after successful expectant management was done in 24 % patients. Most frequently seen complication was wound site collection (72.5%) followed by respiratory tract infections (49%). Total mortality in our study was 12.6% of which 41% was post-operative mortality and 59% mortality seen in patients who expired during conservative management.    Conclusions: This study demonstrates that intra-abdominal adhesions and abdominal tuberculosis account for most cases of intestinal obstruction in countries like India. A watchful expectant management can be tried in patients with prior operative history and those with history of tuberculosis.