The evolution of surgical techniques in clinical liver transplantation. A review

Abstract

Currently, liver transplantation (LT) is an accepted method of treatment of end-stage liver disease, metabolic diseases with their primary defect in the liver and unresectable primary liver tumors. Surgical techniques in LT have evolved considerably over the past 40 yr. The developments have led to a safer procedure for the recipient reflected by continuously improving survival figures after LT. Also the new techniques offer the possibility of tailoring the operation to the needs and condition of the recipient as in partial grafting or in different revascularization techniques, or in techniques of biliary reconstructions. In addition, the new techniques such as split LT, domino transplantation and living donor LT have brought about an increase in the available grafts. In this review the evolution of surgical techniques in LT over the past 40 yr and their contribution to the current results are discussed.

Living Donor Liver Transplantation

“…The flushing is continued through the portal vein until the effluent from the hepatic vein is completely clear. This usually requires 3 mL/g of liver weight (Henrik P et al, 2009;Polak W et al, 2009;Humar A et al, 2006;Tanaka K et al, 2010).…”

“…Attention should be paid to prevent inversion, especially of the posterior wall. There should be no tension on the suture (Polak W et al, 2009;Humar A et al, 2006;Tan H et al, 2007;Tanaka K et al, 2010).…”

“…The vascular stumps are oversewn with Prolene sutures. The donor side of the bile duct is closed after the graft is removed and the vascular stumps are oversewn (Henrik P et al, 2009;Polak W et al, 2009;Humar A et al, 2006). (Cipe G, et al, 2011).…”

“…The hepatic veins are clamped and divided. The hepatic vein stump intended for venous outflow reconstruction is slit open to fashion a triangular venotomy opening that matches in size and shape with the hepatic vein opening of the liver graft (Henrik P et al, 2009;Polak W et al, 2009). …”

“…Recipients with potentially malignant lesions should be explored through a relatively small right subcostal incision before the donor is anesthetized. If enlarged lymph nodes are found, biopsies are sent for frozen section (Henrik P et al, 2009;Polak W et al, 2009). …”