Share This Article:

A Simple and New Device to Avoid Hepatic Venous Outflow Obstruction in Adult Liver Transplantation

Abstract Full-Text HTML Download Download as PDF (Size:291KB) PP. 485-487
DOI: 10.4236/ss.2011.210106    3,971 Downloads   5,819 Views   Citations

ABSTRACT

Hepatic venous drainage in liver transplantation may be reduced to the level of caval anastomosis producing an obstruction degree and leading to serious vascular complication such as the acute Budd-Chiari syndrome, which may result in organ loss. Outflow obstruction may be caused by lack of technique in caval anastomosis or by allograft malposition as a consequence of anatomical graft and recipient conditions. Fixation of the round ligament, placement of bowel loops and use of tissue expanders have been described to stabilize graft position during liver transplantation with related procedure complications. We report our experience of a simple homemade device using a surgical glove expander that allowed us to successfully avoid outflow obstruction in all of nine treated patients. No device related complications occurred. In malposed liver allografts, we strongly suggest the use of this simple and safe device to avoid hepatic venous outflow obstruction on condition that the device is early removed within 48 hours.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

D. Donataccio, S. Grosso and M. Donataccio, "A Simple and New Device to Avoid Hepatic Venous Outflow Obstruction in Adult Liver Transplantation," Surgical Science, Vol. 2 No. 10, 2011, pp. 485-487. doi: 10.4236/ss.2011.210106.

References

[1] P. Parrilla, F. Sánchez-Bueno, J. Figueras, E. Jaurrieta, J. Mir, C. Margarit, J. Lázaro, L. Herrera, M. Gómez-Fleitas, E. Varo, E. Vicente, R. Robles and P. Ramirez, “Analysis of the complications of the Piggy-Back Technique in 1112 Liver Transplants,” Transplantation, Vol. 67, No. 9, 1999, pp. 1214-1217. http://dx.doi.org/10.1097/00007890-199905150-00003
[2] F. Navarro, M. C. Le Moine, J. M. Fabre, J. Belghiti, D. Cherqui, R. Adam, F. R. Pruvot, C. Letoublon and J. Domergue, “Specific Vascular Complications of Orthotopic Transplantation with Preservation of the Retrohepatic Vena Cava: Review of 1361 Cases,” Transplantation, Vol. 68, No. 5, 1999, pp. 646-650. http://dx.doi.org/10.1097/00007890-199909150-00009
[3] G. Krishna Kumar, K. Sharif, D. Mayer, D. Mirza, K. Foster, D. Kelly and A. J. Millar, “Hepatic Venous Outflow Obstruction in Paediatric Liver Transplantation,” Pediatric Surgery International, Vol. 26, No. 4, 2010, pp. 423-425. http://dx.doi.org/10.1007/s00383-010-2564-y
[4] G. Y. Ko, K. B. Sung, H. K. Yoon, K. R. Kim, J. H. Kim, D. I. Gwon and S. G. Lee, “Early Posttransplant Hepatic Venous Outflow Obstruction: Long-Term Efficacy of Pri-Mary Stent Placement,” Liver Transplantation, Vol. 14, No. 10, 2008, pp. 1505-1511. http://dx.doi.org/10.1002/lt.21560
[5] Y. Inomata, K. Tanaka, H. Egawa, S. Uemoto, T. Kiuchi, K. Satomura, S. Uyama and H. Okajima, “Application of a Tissue Expander for Stabilizing Graft Position in Living-Related Liver Transplantation,” Clinical Transplantation, Vol. 11, No. 1, 1997, pp. 56-59.
[6] B. Jawan, H. K. Cheung, C. C. Chen, Y. S. Chen, Y. C. Chiang, C. C. Wang, Y. F. Cheng, T. L. Huang, H. L. Eng, S. Goto, T. L. Pan, V. De Villa, P. P. Liu, S. H. Wang, C. L. Lin and J. H. Lee, “Repeated Hypotensive Episodes Due to Hepatic Outflow Obstruction during Liver Transplantation in Adult Patients,” Journal of Clinical Anesthesia, Vol. 12, No. 3, 2000, pp. 231-233. http://dx.doi.org/10.1016/S0952-8180(00)00146-X
[7] J. Lerut and P. Gertsch, “Side-To-Side Cavo-Cavostomy: A Useful Aid in “Complicated” Piggy-Back Liver Transplantation,” Transplant International, Vol. 6, No. 5, 1993, pp. 299-301. http://dx.doi.org/10.1007/BF00336033
[8] A. C. Stieber, R. D. Gordon and N. Bassi, “A Simple Solution to a Technical Complication in “Piggyback” Liver Transplantation,” Transplantation, Vol. 64, No. 4, 1997, pp. 654-655.
[9] B. Malassagne, B. Dousset, P. P. Massault, D. Devictor, O. Bernard and D. Houssin, “Intra-Abdominal Sengstaken-Blakemore Tube Placement for Acute Venous Outflow Obstruction in Reduced-Size Liver Transplantation,” British Journal of Surgery, Vol. 83, No.8, 1996, p. 1086. http://dx.doi.org/10.1002/bjs.1800830814
[10] J. C. Emond, T. G. Heffron, P. F. Whitington, C. E. Broelsch, “Reconstruction of the Hepatic Vein in Reduced Size Hepatic Transplantation,” Surgery, Gynecology & Obstetrics, Vol. 176, No. 1, 1993, pp. 11-17.
[11] M. D. Darcy, “Management of Venous Outflow Complications after Liver Transplantation,” Techniques in Vascular and Interventional Radiology, Vol. 10, No. 3, 2007, pp. 240-245. http://dx.doi.org/10.1053/j.tvir.2007.09.018
[12] J. Quintela, C. Fernàndez, J. Aquirrezabalaga, C. Gerardo, M. Marini, F. Suarez and M. Gomez, “Early Venous Obstruction after Liver Transplantation and Treatment with Cavo-Cavostomy,” Transplantation Proceedings, Vol. 41, No. 6, 2009, pp. 2450-2452. http://dx.doi.org/10.1016/j.transproceed.2009.06.066
[13] A. Cavallari, M. Vivarelli, R. Bellusci, E. Jovine, A. Mazziotti and C. Rossi, “Treatment of Vascular Complications Following Liver Transplantation: Multidisciplinary Approach,” Hepatogastroenterology, Vol. 48, No. 37, 2001, pp. 179-183.
[14] C. C. Wang, A. M. Concejero, C. C. Yong, Y. S. Chen, S. H. Wang, C. C. Lin, Y. W. Liu, C. H. Yang, T. S. Lin, K. C. Hung, B. Jawan, Y. F. Cheng, S. Ibrahim and C. L. Chen, “Improving Hepatic and Portal Venous Flows Using Tissue Expander and Foley Catheter in Liver Transplantation,” Clinical Transplantation, Vol. 20, No. 1, 2006, pp. 81-84. http://dx.doi.org/10.1111/j.1399-0012.2005.00431.x

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.