Single Orifice Outflow Reconstruction: Refining the Venous Outflow in Modified Right Lobe Live Donor Liver Transplantation

Pamecha, Viniyendra; Pattnaik, Bramhadatta; Sinha, Piyush Kumar; Patil, Nilesh; Mohapatra, Nihar; Sasturkar, Shridhar Vasantrao; Sundararajan, Venkatesh Balaraman; Thapar, Shalini; Sindwani, Gaurav; Arora, Manali

doi:10.1007/s11605-020-04776-3

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…In addition, antegrade hepatic artery perfusion was carried out with 250 to 300 mL of histidine-tryptophan-ketoglutarate using an intravenous infusion set 18 . The back-table procedure for venous reconstruction was performed using a standard procedure 19 . Segment V and VIII veins larger than 5 mm were reconstructed with a poly tetra fluoro ethylene graft, and the neo-MHV (poly tetra fluoro ethylene graft) was then incorporated with the right hepatic vein to create a single orifice.…”

Section: Methodsmentioning

confidence: 99%

“…18 The back-table procedure for venous reconstruction was performed using a standard procedure. 19 Segment V and VIII veins larger than 5 mm were reconstructed with a poly tetra fluoro ethylene graft, and the neo-MHV (poly tetra fluoro ethylene graft) was then incorporated with the right hepatic vein to create a single orifice.…”

Section: Benchingmentioning

confidence: 99%

“…In the case of the right hemilver graft, end-to-side single anastomosis of the graft hepatic vein and neo-MHV to the recipient's IVC was performed as described previously by the single outflow reconstruction technique. 19 For the left lobe, the common opening of MHV and LHV was anastomosed to the recipient left + middle vein junction extending onto the IVC obliquely to have a wide stoma ≥ 4 cm. Any significant inferior hepatic or caudate vein ( ≥ 5 mm) was anastomosed to the IVC.…”

Section: Graft Implantationmentioning

confidence: 99%

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Temporary Portocaval Shunt Provides Superior Intra-operative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation

YL,

Patil,

Mohapatra

et al. 2024

Annals of Surgery

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Objective: The primary objectives were to compare intra operative hemodynamic parameters, blood loss, renal function, and duration of surgery with and without TPCS in live donor liver transplantation (LDLT) recipients. Secondary objectives were post-operative early graft dysfunction (EGD), morbidity, mortality, total ICU and hospital stay. Background: Blood loss during recipient hepatectomy for liver transplantation (LT) remains a major concern. Routine use of temporary portocaval shunt (TPCS) during LT is not yet elucidated. Methods: A single centre, open label, randomized control trial. The sample size was calculated based on intraoperative blood loss. After exclusion, a total of 60 patients, 30 in each arm (TPCS versus no TPCS) were recruited in the trial. Results: The baseline recipient and donor characteristics were comparable between the groups. The median intra-operative blood loss (P = 0.004) and blood product transfusions (P<0.05) were significantly less in TPCS group. TPCS group had significantly improved intraoperative hemodynamics in anhepatic phase as compared to no-TPCS group (P<0.0001), requiring significantly less vasopressor support. This led to significantly better renal function as evidenced by higher intraoperative urine output in TPCS group (P=0.002). Because of technical simplicity, TPCS group had significantly fewer IVC injuries (3.3 vs. 26.7%, P=0.026) and substantially shorter hepatectomy time and total duration of surgery (529.4 ± 35.54 vs. 606.83 ± 48.13 mins, P<0.0001). ). Time taken for normalisation of lactate in the immediate post-operative period was significantly shorter in TPCS group (median, 6 h vs. 13 h; P=0.04). Although post-operative endotoxemia, major morbidity, 90day mortality, total ICU and hospital stay were comparable between both the groups, tolerance to enteral feed was earlier in the TPCS group. Conclusion: In LDLT, TPCS is a simple and effective technique that provides superior intraoperative hemodynamics and reduces blood loss and duration of surgery.

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Section: Methodsmentioning

confidence: 99%

Section: Benchingmentioning

confidence: 99%

Section: Graft Implantationmentioning

confidence: 99%

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Temporary Portocaval Shunt Provides Superior Intra-operative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation

YL,

Patil,

Mohapatra

et al. 2024

Annals of Surgery

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“…All the donors with intestinal obstruction were in group B. Median day of drain removal in EDR group was 3 and RDR group was 5 (3 (3-33) Vs 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13), P = 0.021). Out of 54 donors in group EDR, 8 donors didn't undergo drain removal on POD 3 as per protocol, they all were included in intention to treat -ITT analysis.…”

Section: Post Operative Parametersmentioning

confidence: 99%

Early drain removal after live liver donor hepatectomy is safe - A randomized control trial

Durairaj

Pamecha

Mohapatra

et al. 2022

Preprint

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INTRODUCTION: The aim of current study was to assess safety of early drain removal after live donor hepatectomy (LDH). METHODS: 108 consecutive donors who met the inclusion criteria, were randomized to Early Drain Removal (EDR – post operative day (POD) 3 - if serous and the drain bilirubin level was less than 3 times of serum bilirubin - “3x3” rule) and Routine Drain Removal (RDR – drain output serous and less than 100ml). Primary outcome was to compare the safety. Secondary outcomes was to compare the post-operative morbidity. RESULTS: Pre-operative, intra-operative and postoperative parameters except for timing of drain removal were comparable. EDR was feasible in 46 out of 54 donors (85.14%) and none required re-intervention after EDR. There was significantly better pain relief with EDR (p=0.00). Overall complications, pulmonary complications, and hospital stay were comparableon intention-to-treat analysis. However, pulmonary complications (EDR - 1.9% Vs RDR -16.3% P= 0.030), overall complications (18.8% Vs 36.3%, P= 0.043) and hospital stay (8 Vs 9, P= 0.014) were more in RDR group on per treatment analysis. Bile leaks were seen in three donors (3.7% in EDR group Vs RDR 1.9% in P=0.558), none of them required endobiliary interventions. Re-Exploration for intestinal obstruction was required for 3 donors in RDR (0% vs 5.7%; p-0.079). CONCLUSION: EDR by “3x3” rule after LDH is safe and associated with significantly better pain relief. On per treatment analysis, EDR was associated with significantly less hospital stay, pulmonary and overall complications. Clinical Trial Registry: Clinical Trials.gov - NCT04504487.

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“…4,5). While a single orifice outflow may provide the potential benefit of a shorter warm ischemia time because of a single anastomosis, two separate outflows ensure a higher patency rate in the short (in case of early thrombosis in one outflow) and medium term (compression of outflow secondary to graft regeneration) (8).…”

Section: Mhv Reconstructionmentioning

confidence: 99%

Technical Advancements in Living Donor Liver Transplant

Sarin¹,

Donmez²,

Tokat³

2021

SGO

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Over the past 2 decades, living donor liver transplantation has become a standard and accepted alternative to deceased donor liver transplantation, especially in countries with poor cadaveric donation rates. Numerous innovations in surgical technique along with improved understanding of post-transplant physiology have led to LDLT having comparable and sometimes exceeding outcomes of DDLT. The importance of venous outflow and adequate anterior sectoral drainage to minimize congestion has been central to improving safety and outcomes in LDLT. Portal vein thrombosis, once a contraindication to transplant is now tackled with excellent outcomes with improvement in surgical technique. Understanding of graft hemodynamics and portal flow has significantly increased the graft pool with acceptance of smaller grafts without lowering patient outcomes. Portal flow modulation techniques are routinely being used to minimize graft injury secondary to portal hypertension and the development of small for size syndrome. Innovative techniques for biliary reconstruction have been devised in a bid to minimize biliary complications. Adoption of microsurgical techniques to arterial reconstruction and utilization of extra anatomic arterial inflow has led to significant shrinkage of grafts lost to hepatic arterial dissection and thrombosis. This review highlights a number of technical advancements made in the field of liver transplant surgery made over the past decade; especially focusing on living donor transplantation.

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Single Orifice Outflow Reconstruction: Refining the Venous Outflow in Modified Right Lobe Live Donor Liver Transplantation

Cited by 8 publications

References 26 publications

Temporary Portocaval Shunt Provides Superior Intra-operative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation

Temporary Portocaval Shunt Provides Superior Intra-operative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation

Early drain removal after live liver donor hepatectomy is safe - A randomized control trial

Technical Advancements in Living Donor Liver Transplant

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