Surgical Techniques of Adult Liver Transplantation

Abstract

Summary: Background: Adult liver transplantation remains a challenging procedure which promises cure for a variety hepatic diseases. Methods: The technique of adult liver transplantation is reviewed. Results: Donor hepatectomy has to assure organ procurement with respect to anatomical variations including blood supply to organ‐transplantable organs, careful handling to avoid additional damage and interdisciplinary communication regarding timing and coordination of abdominal and thoracic perfusion. The transplantation itself is characterised by three different phases. Dissection leading to recipient hepatectomy may be rendered difficult not only by portal hypertension but also by previous upper abdominal surgery. The anhepatic phase elicits specific pathophysiology regarding circulation and hemostasis and requires meticulous suturing of vascular anastomosis. Finally, after reperfusion and hemostasis, anastomoses for biliary drainage are performed. The most common early surgical complications are briefly described. In this review, special emphasis is placed on personal experience and fine points of surgical technique. Conclusions: Correct surgical techniques are a prerequisite for immediate and optimal graft function and patient survival.

Editorial

“…Based upon a comparitively large personal experience acquired under the guidance of Neuhaus , the author (WOB) describes surgical techniques in a detailed fashion, highlighting pitfalls and potential errors in surgical technique. (2) The basis for successful outcome of liver transplantation rests upon a perfect procurement. Recognition of anatomical variations and properly adapted techniques, always with respect to simultaneous retrieval of the pancreatic graft, are important cornerstones even before the start of perfusion with organ preservation solution.…”