Upper Midline Incision in Recipients of Deceased-Donors Liver Transplantation

Abstract

Background: Liver transplant (LT) is the only effective and long-lasting option for patients with end-stage liver disease. Innovations and refinements in surgical techniques occurred with the advent of transplants with partial grafts and laparoscopy. Despite these modifications, the abdominal incision remains with only few changes. Aim: Demonstrate the experience with the upper midline incision in LT recipients with whole liver grafts from deceased donors. Methods: Retrospective study with patients submitted to LT. Data were collected from the recipients who performed the surgical procedure through the upper midline incision. Results: The upper midline incision was used in 20 LT, 19 of which were performed in adult recipients. The main cause was liver disease secondary to alcohol. Male, BMI>25 kg/m² and MELD greater than 20 were prevalent in the study. Biliary complications occurred in two patients. Hemoperitoneum was an indication for reoperation at one of the receptors. Complication of the surgical wound occurred in two patients, who presented superficial surgical site infection and evisceration (omental). Two re-transplant occurred in the first postoperative week due to severe graft dysfunction and hepatic artery thrombosis, which were performed with the same incision, without the need to increase surgical access. There were two deaths due to severe graft dysfunction after re-transplant in 72 h and respiratory sepsis with multiple organ dysfunction in the third week. Conclusion: The upper midline incision can be safely used in LT recipients with whole grafts from deceased donors. However, receptor characteristics and hepatic graft size should be considered in the option of abdominal surgical access.

Reconstruções Arteriais No Backtable Do Transplante De Fígado: Onde Estamos?

“…Na literatura, as alterações anatômicas da artéria hepática variam de 20-50% e existem diversas classificações que organizam de forma sistemática cada uma dessas alterações, sendo a classificação de Michel a mais utilizada. 1,2 Dessa forma, no transplante hepático, as reconstruções em backtable são comumente necessárias, afim de obter anastomoses arteriais adequadas. 11 As complicações vasculares, após transplante hepático aumentam de forma significativa a morbidade e podem contribuir, por exemplo, para a perda do enxerto e isquemia biliar.…”

“…No transplante hepático ortotópico, as reconstruções arteriais no backtable são fundamentais para que anastomoses arteriais apropriadas sejam proporcionadas ao paciente. Sendo assim, o conhecimento das variações anatômicas das artérias é necessário, a fim de garantir a qualidade da reconstrução e evitar possíveis complicações durante esse processo, 1,6 como por exemplo, o retransplante, as complicações biliares e a trombose da artéria hepática (TAH).…”

Minimizing Incision in Living Donor Liver Transplantation: Initial Experience and Comparative Analysis of Upper Midline Incision in 115 Recipients

“…Midline incisions allow for easy left lobe mobilization and access to the suprahepatic vena cava and provide good exposure for both the hepatic and portal vein anastomoses [ 2 ]. This approach has been safely used in LT recipients receiving whole grafts from deceased donors [ 6 ]. Additionally, a midline incision extending from the xiphoid process to the pubis has been reported to be adequate for hepatectomy, native nephrectomy, and simultaneous liver-kidney (SLK) transplantation in patients with polycystic disease [ 5 ].…”

“…In the initial phase of the study, the exclusion criteria were outlined as previously described. After the first five cases, the team consistently utilized an upper midline incision for all subsequent cases, regardless of recipient characteristics like BMI, height, etc., which may have suggested a limited working field [ 6 ]. The incision was extended as needed based on the situation keeping patient safety as our primary objective.…”

Impact of Meld Sodium on Liver Transplantation Waiting List

“…In Brazil, the first transplant was carried out in 1968 at the Hospital das Clínicas, Medical School, University of São Paulo 7 . Since then, the number of transplants performed in the country has significantly increased 8 , 12 . Thus, it was necessary to create criteria to organize the list of patients waiting for an organ.…”