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Transhilar Passage in Right Graft Live Donor Liver Transplantation: Intrahilar Anatomy and Its Impact on Operative Strategy
Author(s) -
Radtke A.,
Sotiropoulos G. C.,
Molmenti E. P.,
Sgourakis G.,
Schroeder T.,
Beckebaum S.,
Peitgen H.O.,
Cicinnati V. R.,
Broelsch C. E.,
Broering D. C.,
Malagó M.
Publication year - 2012
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2011.03827.x
Subject(s) - medicine , anastomosis , liver transplantation , bile duct , surgery , transplantation , living donor liver transplantation
The passage through the hilar plate during right graft live donor liver transplantation (LDLT) can have dangerous consequences for both donors and recipients. The purpose of our study was to delineate hilar transection and biliary reconstruction strategies in right graft LDLT, with special consideration of central and peripheral hilar anatomical variants. A total of 71 consecutive donors underwent preoperative three‐dimensional (3D) CT reconstructions and virtual 3D hepatectomies. A three‐modal hilar passage strategy was applied, and its impact on operative strategy analyzed. In 68.4% of cases, type I and II anatomical configurations allowed for an en block hilar transection with simple anastomotic reconstructions. In 23.6% of cases, donors had “difficult” type II and types III/IV hilar bile duct anatomy that required stepwise hilar transections and complex graft biliary reconstructions. Morbidity rates for our early (A) and recent (B) experience periods were 67% and 39%, respectively. (1) Our two‐level classification and 3D imaging technique allowed for donor‐individualized transhilar passage. (2) A stepwise transhilar passage was favored in types III and IV inside the right‐sided hilar corridor. (3) Reconstruction techniques showed no ameliorating effect on early/late biliary morbidity rates.