A comparative study between stapled and sutured side-to-side cavo-caval anastomosis for outflow reconstruction in deceased donor liver transplants

Mohanka, Ravi; Nikam, Vinayak; Rao, Prashantha; Shrimal, Anurag; Golhar, Ankush; Shah, Mitul; Kamath, Saurabh; Banker, Amay

doi:10.1097/lvt.0000000000000194

Liver Transplantation

2023

DOI: 10.1097/lvt.0000000000000194

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A comparative study between stapled and sutured side-to-side cavo-caval anastomosis for outflow reconstruction in deceased donor liver transplants

Ravi Mohanka

Vinayak Nikam

Prashantha Rao

et al.

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2024

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Cited by 2 publications

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“…To the editor, We thank Kalinowski and colleagues for their insightful comments regarding our recent article, titled "A comparative study between stapled and sutured side-to-side cavo-caval anastomosis for outflow reconstruction in deceased donor liver transplants," published in Liver Transplantation. [1,2] We appreciate their interest in our work and are pleased to learn about their experience with a similar technique. Our experience has also evolved since we did the study and the following are some more procedural nuances in our stapled technique.…”

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confidence: 99%

Reply: Stapled cavo-cavostomy in liver transplantation—Well-known tools in a new technique

Banker,

Mohanka,

Rao

et al. 2024

Liver Transplantation

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confidence: 99%

Reply: Stapled cavo-cavostomy in liver transplantation—Well-known tools in a new technique

Banker,

Mohanka,

Rao

et al. 2024

Liver Transplantation

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Letter to the Editor: Stapled cavo-cavostomy in liver transplantation—Well-known tools in a new technique

Kalinowski,

Kruk,

Grąt

2024

Liver Transplantation

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To the editor, We read with great interest the article by Ravi Mohanka et al [1] entitled "A comparative study between stapled and sutured side-to-side cavo-caval anastomosis for outflow reconstruction in deceased donor liver transplants," recently published in Liver Transplantation. The authors presented a series of 17 patients who underwent OLTx with stapled side-toside cavo-caval anastomosis. It is a simple and safe alternative to sutured side-to-side cavo-caval anastomosis that reduces the time of anastomosis. This was consistent with the results of our team from Warsaw, which showed that stapled side-to-side cavo-caval anastomosis was feasible and at least as safe as a conventional sutured anastomosis. [2] We would like to comment on the technique that we developed performing more than 35 OLTx with stapled cavocavostomy this year. Since the beginning of the use of stapled anastomosis in late 2022, we have focused on safety. One of the steps during the procedure is temporary IVC cross-clamping, which may result in hemodynamic instability and acute kidney injury. The solution was a conversion from cross-clamping with 2 straight clamps to tangential occlusion with a Satinsky clamp immediately after firing the stapler. It shortened the cross-clamping time from an initial average of 15:18 minutes to 4:56 minutes in the last 10 cases. A short period of cross-clamping may be a negligible factor considering the possible risk in most patients. Mohanka et al [1] used a second stapler to elongate the anastomosis. This approach was also mentioned by Akbulut et al. [3] However, it may be not feasible in all cases since the proximal limitation depends on the level of the upper vascular clamp on the recipient IVC which is initially placed as high as possible. A refinement of this approach and a randomized study with properly selected recipients of liver transplant will be necessary to compare this novel approach with established techniques.

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A comparative study between stapled and sutured side-to-side cavo-caval anastomosis for outflow reconstruction in deceased donor liver transplants

Cited by 2 publications

References 3 publications

Reply: Stapled cavo-cavostomy in liver transplantation—Well-known tools in a new technique

Reply: Stapled cavo-cavostomy in liver transplantation—Well-known tools in a new technique

Letter to the Editor: Stapled cavo-cavostomy in liver transplantation—Well-known tools in a new technique

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