The ping-pong ball as a surgical aid in liver transplantation

Jones, Vanessa; Thomas, Gordon; Stormon, Michael; Shun, Albert

doi:10.1016/j.jpedsurg.2008.05.022

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…A few studies involving TE application have been sporadically reported worldwide, in which the majority of patients were pediatric recipients. A report using ping-pong balls instead of a TE has been reported [9]. To the best of our knowledge, this is the first case series on TE application covering both pediatric and adult recipients.…”

Section: Discussionmentioning

confidence: 86%

Application of a tissue expander to stabilize graft position in liver transplantation

Kang

Hwang

Ahn

et al. 2021

Ann Liver Transplant

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A small-sized left liver graft may fall into the large right subphrenic fossa, in which such a size mismatch can result in graft hepatic vein outflow obstruction as well as excessive stretching of the reconstructed portal vein. A tissue expander (TE) was used to prevent detrimental dextro-rotation of the liver graft through obliteration of the dead space at the right subphrenic fossa. We herein present our experience regarding TE application in liver transplantation (LT). TEs of various sizes and shapes are commercially available, and the dome-shape TEs with an external connecting tube and an injection port are the most frequently used. The indications for TE application can be classified into four categories: pediatric LT cases using a living-donor or split deceased-donor left-sided liver graft, adult LT cases using a living-donor left liver graft, LT with dual-graft implantation, and unusual conditions such as a recipient with situs inversus. The underlying cause of TE application is basically identical in all four categories, but the technical details of TE application differ from each other. The timing of TE removal depends on the degree of graft regeneration and the amount of water within the TE, which is usually 1 to 3 weeks after LT. We experienced no serious adverse TE-associated complications in more than 100 cases. In conclusion, TE application is simple, safe, and effective to provide mechanical support for the liver graft, and therefore performed readily if indicated.

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Section: Discussionmentioning

confidence: 86%

Application of a tissue expander to stabilize graft position in liver transplantation

Kang

Hwang

Ahn

et al. 2021

Ann Liver Transplant

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“…To counteract this, supportive devices, such as expanders or balloons, which elevate the graft anteriorly and alleviate tension in the hilar structures, can be strategically positioned posterior to the graft. [14] A meticulous examination of the graft's hilar structures is imperative, especially when considering a 180° sagittal plane rotation for heterotopic transplantation. In the standard transplantation procedure, the recipient's hilar structures follow a sequence from anterior to posterior: bile duct, hepatic artery, and portal vein.…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Reversed Position Technique in Pediatric Liver Transplantation

Ersan

2023

J Inonu Liver Transpl Inst

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T he evolution of liver transplantation (LT), especially in the pediatric population, has been marked by significant milestones and innovations. With the increasing demand for organs, attention was shifted towards living donor liver transplantation (LDLT). The first LDLT was performed in the late 1980s, and over the years, surgical techniques were refined, making LDLT a valuable procedure for pediatric patients, especially in regions with limited organ donation from deceased donors. [1,2] Despite these advances, challenges persist, especially when transplanting large grafts into small pediatric patients. Technical difficulties, such as increased intraabdominal pressure and challenges in abdominal closure, have been significant concerns. [3] Primary closure of the abdomen may lead to elevated intra-abdominal pressure. This can result in inflow or outflow obstructions in the implanted graft, an extended need for mechanical ventilation due to increased intrathoracic pressure, the development of abdominal compartment syndrome, associated renal Objectives: Many challenges persist, especially when transplanting large grafts into small pediatric patients in liver transplantation (LT). In this study, we will discuss the details of the "heterotopic reversed position technique" in LT, which is applied to prevent complications and allows primary closure of the abdomen in the initial surgery without causing an increase in intra-abdominal pressure. Methods: From March 2002 to December 2021, our institution performed 3121 LT of these 691 (22.1%) were pediatric LT. We present the outcomes of 11 pediatric patients who underwent LT using this method. Results: In the postoperative phase, none of the 11 cases had vascular complications. Five of the cases were alive for an average of 9.2 years. The causes of mortality in the three cases were due to persistent hepatic encephalopathy after surgery in one case, another due to hemodynamic instability in the early postoperative period, and the third due to graft-versus-host disease that manifested two months after surgery. Conclusion:The reversed positioning technique offers a promising solution to the challenges of pediatric liver transplant, especially in cases of acute fulminant liver failure.

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“…Besides, some of the liver grafts have large anteroposterior diameters and can compress the cava impeding venous return. We have tended to support these grafts with prosthetic materials to ensure optimal flow to and from the graft (15).…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in children with hyper-reduced grafts - A single-center experience

Thomas¹,

Thomas²,

Verran

et al. 2010

Pediatric Transplantation

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In small infants and babies who receive split or living-related adult left lateral segmental liver grafts, further reduction (hyper-reduction) of the graft may be necessary to optimize the size of the graft for the child. We report our experience with hyper-reduction of adult left lateral segment grafts in nine children. A retrospective review of the medical records of children who received hyper-reduced grafts at the Children's Hospital at Westmead, Australia was performed. Of 215 liver transplants performed on 186 children between 1986 and May 2009, 147 were reduced grafts. Nine grafts were further reduced (hyper-reduced) after an on-table assessment of graft size relative to the available abdominal space was made. Mean graft size reduction was by 30%. The pledgetted technique of resection was used in four patients. All required delayed closure of the abdomen, and in three patients, fascial closure was not possible and a Surgisis patch (Cook Surgical International, West Lafayette, IN, USA) was placed to augment the abdominal capacity. Two children had hepatic artery thrombosis. One was successfully thrombectomized. In the other, technical problems with the donor liver contributed to death 10 days post-transplant. Two bile leaks, one from the cut surface and the other at the anastomotic site, were oversewn at the time of abdominal closure. On follow-up (median 33 months), two developed biliary strictures requiring dilatation. Hyper-reduction of segmental grafts can be safely performed when needed. In view of its versatility, it may be preferable to hyper-reduce a graft rather than use a monosegment graft. Comparable long-term results are possible. The pledgetted technique of resection is easy, quick, and safe. The fact that it can be performed after revascularization with minimal blood loss adds great flexibility to this technically challenging procedure.

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The ping-pong ball as a surgical aid in liver transplantation

Cited by 5 publications

References 14 publications

Application of a tissue expander to stabilize graft position in liver transplantation

Application of a tissue expander to stabilize graft position in liver transplantation

Heterotopic Reversed Position Technique in Pediatric Liver Transplantation

Liver transplantation in children with hyper-reduced grafts - A single-center experience

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