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How to explant a diseased liver for living donor liver transplantation after previous gastrectomy with severe adhesion (with video)
Author(s) -
Eguchi Susumu,
Soyama Akihiko,
Takatsuki Mitsuhisa,
Hidaka Masaaki,
Adachi Tomohiko,
Kitasato Amane,
Baimakhanov Zhassulan,
Kuroki Tamotsu
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.120
Subject(s) - hepatoduodenal ligament , medicine , anatomy , duodenum , adhesion , transplantation , surgery , falciform ligament , liver transplantation , dissection (medical) , ligament , hepatectomy , inferior vena cava , chemistry , organic chemistry , resection
We performed living donor liver transplantation ( LDLT ) in a patient who had undergone distal gastrectomy for gastric ulcer disease with B illroth I reconstruction 30 years before the LDLT . The adhesion was very severe between remnant stomach and hepatic hilum as well as left liver lobe with shortening of hepatoduodenal structures. After dissection of the infrahepatic inferior vena cava, the S piegel lobe was identified from the dorsal side. The S piegel lobe was then penetrated with a right angle dissector so that a plastic tape could be placed around the whole adhesion, including important structures in the hepatoduodenal ligament. Next, the right hepatic vein was transected with a vascular stapler using P ringle's maneuver using the plastic tape to fasten the entire adhesional structure. Subsequently, the trunk of the middle and left hepatic vein was transected after clamping. The remaining short hepatic veins in the left side were divided completely from the cranial to the caudal direction to dissect Spiegel's lobe. Finally, the hepatoduodenal ligament was identified from the attached remnant stomach and the duodenum and a vascular clamp was placed on the entire hepatoduaodenal ligament. Finally, the diseased liver was explanted for graft implantation. Thus, retrograde explantation of the liver was effective in decreasing the risk of damaging vital elements in the hepatoduodenal ligament, the remnant stomach, and the duodenum.