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Rationale: Adult-to-adult right lobe living donor liver transplantation is a  viable alternative to whole liver transplantation from a  deceased donor. The key aspect of the surgical procedure is the restoration of adequate graft blood flow and maintenance of sufficient volume of well vascularized parenchyma in the donor. Specific features of vascular anatomy in the donor and the recipient can be eventual cause for significant technical difficulties during transplantation. They can also increase the risk of complications and deteriorate graft functioning.Aim: To identify the incidence of various types of afferent and efferent vascularization of right lobe of the liver, potential techniques of vascular reconstructive procedures, rates and types of postoperative complications, as well as immediate surgical results.Materials and methods: We retrospectively analyzed the data on 220 right lobe liver transplantations adult patients, consecutively performed from 2010 to 2017 in one center. Specific characteristics of liver vascularization in donors and recipients were determined by pre-operative computed tomography and intra-operatively. The information on the types of vascular reconstruction, complications and results of surgical procedures was obtained from patients' medical files.Results: The following variants of blood supply to the right liver lobe were seen most frequently: portal vein trifurcation 22%, shortened trunk of the right portal vein branch 13%, supplementary v. hepatica from SgVIII with a diameter of > 5 mm 22%, supplementary lower right v. hepatica 17%, isolated venous outflow from all right lobe segments 2%, two arteries 2%. In addition, 17% of the recipients had portal vein thrombosis and 1% portal vein fibrosis. During the follow-up all donors remained alive. The rate of surgical complications was 12.5%, among them bile pocket or biloma 8.5%, intra-abdominal bleeding 2.5%, wound complications 1.5%. The rate of early post-operative complications in the recipients was 31.5%, with 4.5% of them being vascular and 15.5% biliary. The 6-months and 4-years survival of the recipients (Kaplan-Meier) was 98% and 95%, respectively.Conclusion: Immediate and longterm survival of the recipients of living donor right lobe live grafts, as well as absence of fatalities among their donors, confirm high effectiveness and expedience of this type of intervention. The observed anatomic variety of blood supply to the right liver lobe stipulates stringent requirements to the quality of preoperative diagnostics, deliberate donor selection, thorough planning of the procedure and high qualification of the surgical team. A  relatively high rate of postoperative complications warrants the necessity of an intensive diagnostic monitoring in the early post-operative period and active strategies of their correction.

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The  OBJECTIVE  is  to  study  the  effect  of application of different  pancreatic stump  closure techniques to  the  postoperative period,  the frequency and  severity  of postoperative complications including postoperative pancreatic fistulas  after distal pancreatectomies. MATERIAL AND METHODS.  The  clinical  material  consisted of 126  patients who  underwent distal  pancreatectomies  (isolated or  in  combination  with  surgical   interventions  on  the  adjacent organs of  the  abdominal cavity  and retroperitoneal space).  The  patients  were   divided  into  4  groups  depending  on  the  pancreatic  stump   closure  techniques (isolated suturing  of the  main  pancreatic duct  of the  pancreatic stump  with its omentization by gastrocolic omentum or local sealing its  by  hemostatic sponge  (control  group);  using  a  local  biological  glue  2-octylcyanoacrylate; using  the  Endoscopic Linear  Cutter  Echelon; external transduodenal  transnasal  drainage of the  enlarged main  pancreatic duct  of the  pancreatic stump). We  evaluated the  influence   of  different  pancreatic stump   closure techniques  after  distal  pancreatectomies on  the postoperative period  as well the  frequency and  severity  of postoperative pancreatic fistulas  depending on the  diameter of the main  pancreatic duct  of pancreatic stump.   RESULTS.  The  overall  rate  of postoperative  complications in the  control  group of patients was  45.8  %, and  was  due  to an  increase in the  frequency of specific  complications (35.4  %). The  most  frequent complication  in  the  control  group   of  patients  was   postoperative  pancreatic  fistulas   –  29.2   %.  The  statistically   significant decrease  of  frequency  and   severity   of  postoperative  complications,  frequency  and   severity   of  postoperative  pancreatic fistulas and decrease of postoperative hospital-stay after the application of the proposed different pancreatic stump closure techniques were  revealed in comparison with the  control  group  of patients. There  was  no  hospital  mortality.  CONCLUSION. Distal  pancreatectomy with  «standard»  pancreatic stump   closure techniques  accompanied by  high  frequency and  severity of postoperative complications, as well as postoperative pancreatic fistulas. The use of the proposed pancreatic stump closure techniques after  distal  pancreatectomy led  to  a  decrease of  the  frequency and  severity   of  postoperative  complications, a decrease of the  frequency and  severity  of postoperative pancreatic fistulas,  and  a decrease of the  postoperative hospital-stay.