During TEP hernia repair, CMOR and/or pubic branch of inferior epigastric artery can be damaged. To prevent this complication, tacks should be stapled to Cooper's ligament close to symphysis pubis and dissection should be careful on the posterior surface of superior pubic ramus. Small caliber (<2 mm) arterial CMOR is more prone to be injured during TEP procedure. To explore venous structures properly, pressure in workspace should be kept as low as possible.
Objectives: In this study, we share our approach for care of patients with hepatic venous outlet obstruction after living-donor liver transplant. Results: Patients ranged in age from 1 to 61 years (24 adults and 11 children). All adult patients had undergone right lobe living-donor liver transplant. In the pediatric group, 8 had undergone left lateral segment and 3 had undergone left lobe living-donor liver transplant. Nineteen adult patients and all 11 pediatric patients underwent hepatic venous reconstruction, with all procedures based on common large-opening drainage models using various vascular graft materials. Development of hepatic venous outlet obstruction occurred at mean posttransplant day 233 ± 298.5 in the adult patients and mean posttransplant day 139 ± 97.8 in the pediatric patients. After development of obstruction, the patients underwent 1-6 sessions (1.5 ± 1.1 sessions) of balloon angioplasty. After the first balloon angioplasty procedure, 25% of the adults and 36.3% of the pediatric patients developed recurrence. The early-onset and late-onset subgroups showed statistically significant differences in serum albumin (P = .01), underlying causes (P < .001), time from transplant to obstruction (P = .02), and time from transplant to last visit (P = .02). The survivor and nonsurvivor subgroups showed statistically significant differences in total bilirubin (P = .03) and time from transplant to last visit (P = .03). Conclusions: Common large-opening reconstruction minimizes hepatic venous outlet obstruction development after living-donor liver transplant. Balloon angioplasty and/or stenting is almost always the first option in the care of this complication.
Materials and Methods
Key words: Balloon angioplasty, Venous outflow, Venous reconstruction models
IntroductionSince the time of the first successful liver transplant in humans (performed by Starzl and colleagues in 1967), liver transplant has emerged as the standard treatment option for a wide array of liver disorders and mainly those related to chronic liver diseases. [1][2][3][4] Although deceased-donor liver transplant (DDLT) constitutes a large percentage of liver transplant procedures performed in Western countries, most liver transplant procedures performed in many of the Asian countries (including Turkey) use organs obtained from living donors (that is, living-donor liver transplant; LDLT). 1 The surgical techniques of DDLT and LDLT differ, as do the posttransplant liver functions resulting from each.One of the most notable differences in the techniques is the reconstruction approach for venous outflow, which is necessary to ensure proper and adequate hepatic drainage. 3 In DDLT, various wide anastomoses are reconstructed between the donor's inferior vena cava (IVC) and the recipient's retrohepatic IVC; this approach lowers the rate of postoperative drainage complications to acceptable levels. In contrast, for LDLT, the reconstruction approach is complicated by the presence of multiple venous orifices in the liver grafts, as well as...
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