Is Autologous Peritoneal Patch a Suitable Material to Creating Circumferential Fence for Hepatic Outflow in Living Donor Liver Transplantation


Barut B., Kutlutürk K., Başkıran A., Otan E., Akbulut A. S., İnce V., ...More

22nd Annual International Congress on ILTS, Seoul, South Korea, 4 - 07 May 2016, vol.100, pp.248

  • Publication Type: Conference Paper / Summary Text
  • Volume: 100
  • City: Seoul
  • Country: South Korea
  • Page Numbers: pp.248
  • Inonu University Affiliated: Yes

Abstract

Background: Most ideal procedure to limit graft congestion following living donor liver transplantation (LDLT) is integration of all venous structures (V5, V8, MHV, RIHV etc.) into the drainage model. Determining phase of this model is the formation of circumferential fence using various artificial (PTFE, Dacron) and autologus (safen vein, iliac artery, iliac vein, vena cava inferior, aortic vasculary graft) vasculary grafts. As far we know, there is not any case of LDLT with a circumferential fence of autologus peritoneal patch among English literature. This study aims to conduct a discussion about suitability of peritoneal patch for circumferential fence in LDLT.


Method: Consecutive 31 LDLT cases with autologus peritoneal patch for hepatic venous reconstruction (circumferential fence) from September 2013 to July 2014 are analyzed retrospectively. All backtable reconstructions were prepared by the same senior surgeon experienced in LDLT. Multidetector Computerised Tomography (MDCT) was performed on postoperative day 7 and 10, doppler ultrasonography was performed on postoperative day 1 and 3 to evaluate vasculary structures.


Results: A sum of 31 patients with an age range from 17 to 75 underwent right lobe LDLT. None of the patients presented hepatic vein outflow obstruction (HVOO) during early postoperative period (<30 days). Seven (7) patients died during postoperative early period due to conditions unrelated to HVOO. Among the remaining 24 patients, HVOO develop in 6 cases (25%) during late postoperative period (>30 days). Ascites was clinically present in 5 and diagnosed incidentally with MDCT in 1 of the HVOO patients. Baloon dilatation was efficient for 4 patients and additional stent application was
required for 2 patients.


Discussion: Circumferential fence application is essential for drainage. In our institution, HVOO developed among 3,49% of 1011 LDLT cases with circumferential fence. However, HVOO developed in 25% of the cases with peritoneal patch circumferential fence. Therefore, we do not recommend peritoneal patch circumferential fence except obligatory conditions