Recanalized umbilico‐caval anastomosis as a temporary portosystemic shunt in pediatric living donor liver transplantation: the crossed fingers method

Abstract

A temporary portocaval shunt (TPCS) associated with retrohepatic vena cava preservation prevents the edema caused by splanchnic congestion during liver transplantation (LT), especially for non-cirrhotic cases. We herein report a modified TPCS technique using the recanalized umbilical vein and an end-to-side recanalized umbilico-caval anastomosis for use during pediatric living donor liver transplantation (LDLT). This work evaluated a group of pediatric patients who underwent LDLT between 2001 and 2014 with the conventional TPCS (n=16) vs the recanalized umbilico-caval shunt (the crossed fingers method, n=10). The crossed fingers method was performed by suturing an end-to-side anastomosis of the patent or recanalized umbilical vein to the vena cava using a continuous monofilament suture like "crossing the fingers," that is, placing the left portal vein across the portal vein trunk next to it. The preoperative, surgical, and postoperative characteristics were similar in both groups except for the significantly shorter portal vein clamping time for the crossed fingers method. This method can allow the portal circulation to be totally decompressed before and after implanting the graft and while maintaining the hemodynamic stability throughout all stages of pediatric LDLT.

Novel Approach via the Round Ligament in Portal Vein Embolization

“…Surgically opening the round ligament exposes a tubular structure that is connected to the umbilical portion of the liver [6,7]. However, the round ligament has also been found to spontaneously recanalize in patients with portal hypertension, which has likewise been proven to be useful in several other surgeries [8,9]. Clinically, the round ligament may also be effectively used in various situations such as a patch or graft for large vessel resection [9][10][11], vascular pedicle in closing a wound around the gastroduodenal artery stump to prevent bleeding after pancreatoduodenectomy [12], or reinforcement of an enteral tube to prevent peritonitis [13].…”