A modified technique for hepatic artery reconstruction in living donor liver transplantation

Abstract

Reconstruction of the hepatic artery (HA) is challenging, because there are technical difficulties. Especially, it is difficult to repair the posterior wall. In 2006, we reported an experimental study of the posterior wall first continuous suturing combined with the interrupted suturing and we also confirmed the safety of this procedure. In this article, we report our clinical experiences using this procedure for the HA reconstruction in living-donor liver transplantation. First, we repaired the posterior wall of the HA with continuous suturing. Then, the anterior wall is repaired with the interrupted suturing using a nylon suture with double needle. Between 2006 and 2009, we performed 13 HA reconstructions using our procedure. In all patients, the HA reconstruction was completed easily and uneventfully without oozing from the posterior wall or postoperative HA thrombosis. Our procedure has the benefits of both continuous and interrupted suturing. We believe that it is useful for reconstruction of the HA in living-donor liver transplantation.

Hepatic Arterial Complications after Liver Transplantation: A Single-Center Experience

“…Surgical techniques have been known as major factor for hepatic artery thrombosis. The key points in hepatic artery reconstruction included selecting a reciprocal stump location for arterial reconstruction: a thicker and healthy arterial stump in the recipient was chosen for the first anastomosis (18). When separating the arteries from surrounding structures, it is important to preserve plenty of soft tissue around the artery.…”

Arterial Anastomosis in Living Donor Liver Transplantation

“…For a HA with a diameter of at least 3.0 mm, 8-0 suture is indicated. For a HA with a diameter less than 3.0 mm, 9-0 suture is indicated (Okochi M et al, 2010). The monofilament suture can be nylon (Ethilon; Ehicon Inc, Somerville, NJ) or polypropylene (Prolene; Ehicon Inc, Somerville, NJ).…”

“…Some authors describe the placement of continuous suture on the posterior wall and interrupted sutures on the anterior wall. (Okochi M et al, 2010) An alternative surgical technique that avoids interpositional vessel grafts or tension on the connection is successfully used by some authors. An end-to-side anastomosis is performed between allograft hepatic vein and recipient inferior vena cava in a more caudate location.…”

“…A diagnosis of vessel obstruction or thrombosis made by DUS (Figure 8) had to be confirmed by 3D CT angiography ( Figure 9). (Okochi et al, 2010) In donors who underwent 2-in-1 segmental resection of the hepatic arteries, DUS is carried out on the second postoperative day and before discharge. Fig.…”

Numerical simulation of a plasma actuator based on ion transport

“…15 In contrast, flows controlled by using PAs (e.g., boundary layers) usually have much longer time scales. Therefore, in the studies of flow control using PAs, steady body force models [16][17][18] are often used to save computational cost, instead of using timeresolved body force fields. Although such steady body force models may intuitively be accepted when the frequency of flow is much lower than that of the PA, the range of frequency ratios in which the far-field flow behavior can reasonably be predicted (which should be the bottom line for the assessment of flow control performance) is not always clear; hence it should be studied systematically.…”