ABSTRACT
Complications relating to the bile ducts are still the single most important technical cause of morbidity following living related liver transplantation. In living related liver transplantation, a single case (of more than 2000 reported cases) of biliary reconstruction by means of a duct-to-duct biliary anastomosis has been reported. The technique of duct-to-duct biliary anastomosis in living related liver transplantation is described herein. The technique can only be used when no tension is applied to the anastomosis and the cut ends of the bile ducts are clearly visible. A Roux-en-Y operation must be performed if these conditions are not fulfilled.
Subject(s)
Bile Ducts/surgery , Liver Transplantation/methods , Anastomosis, Surgical , Hepatectomy , Humans , Living Donors , Tissue and Organ Harvesting/methodsABSTRACT
Split liver transplantation was introduced to alleviate the organ shortage. Comparable morbidity, graft, and patient survival rates have been reported with the use of either split or whole liver for transplantation. This article gives a detailed illustrated report of our splitting technique. Alternative techniques are also discussed. Both techniques of in situ vs ex situ splitting should be developed according to the logistical possibilities. Depending on the desired volume of the left graft, the cutting line may be shifted, particularly to the right of the middle hepatic vein, the whole of segment 4 being then included in the left graft (when the recipients are 2 adults). Split liver transplantation increases graft availability by 15% to 28%. At present, the goal of split liver transplantation clearly has to be its clinical application in 2 adults to tackle the problem of organ shortage in this population, which accounts for more than 90% of deaths in those who are on the waiting list.