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- W2960586294 abstract "Background and Aims: Numerous variations in surgical techniques have been proposed to establish adequate venous outflow in LDLT. We sought to simplify this process and propose a single outflow technique for all LDLT grafts. Methods: Retrospective review of past DDLT and first 100 odd LDLT experience (Group 1 - variety of outflow reconstruction techniques) in our program led to the development of a unified LDLT outflow technique, a single large outflow orifice at least 3 cms in size with a venous fence at the site of anastomosis with the recipient cava. Patch/quilt venoplasty was used to unify small veins openings (>5 mm) into larger ones, to unify the MHV/neo-MHV (tube graft) and RHV openings, S2 and S3 or LHV and accessory outflow veins, rather than suturing them primarily, to avoid distortion and narrowing of the outflow orifice. The material used was deceased donor venous grafts, veins harvested from explant liver or reinforced PTFE grafts. Prospective assessment of this “unified outflow” in the past 121 LDLT's (Group 2), using serial Doppler in the first 6 months after LT along with collection of pre-, peri- and post-operative laboratory, imaging and clinical data was carried out. Results: Time period Jan 2012–Dec 2017 [follow-up median (range): 39 months (10–76)]. Total number of transplants 387 (DDLT 162; LDLT 225). (Table 1). Conclusions: This unifying technique to result in a single large cloaca results in a well-drained graft and can be used for both R and L lobe implants, irrespective of the initial graft outflow anatomy.Tabled 1Table 1LDLTR lobeR lobe with sub-total MHVL lobeLLS, reduced LLS and monosegmentBench time (minutes)WIT 2 (minutes)Outflow obstruction needing interventionGroup 1114752118042 (35–66)51 (33–62)3 (HV stent)Group 2111473821591 (62–125)43 (40–73)0 Open table in a new tab The authors have none to declare." @default.
- W2960586294 created "2019-07-23" @default.
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- W2960586294 date "2019-05-01" @default.
- W2960586294 modified "2023-10-14" @default.
- W2960586294 title "44. A “Unifying Cloaca” Technique for Achieving Adequate Outflow in Living Donor Liver Transplantation Irrespective of Individual Graft Anatomy" @default.
- W2960586294 doi "https://doi.org/10.1016/j.jceh.2019.04.047" @default.
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