gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

A single center experience of 1000 liver transplants using the modified piggyback technique by Belghiti

Meeting Abstract

  • Arianeb Mehrabi - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Hamidreza Fonouni - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Mohammad Golriz - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Mohammadreza Hafezi - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Peter Schemmer - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch135

doi: 10.3205/14dgch135, urn:nbn:de:0183-14dgch1356

Veröffentlicht: 21. März 2014

© 2014 Mehrabi et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Over the past 4 decades, the surgical techniques of liver transplantation (LTx) have permanently evolved and been modified. Among these, the modified piggyback (MPB) technique by Belghiti offers specific advantages. The objective of this study was to present our single-center experience with the MPB technique in 1000 cases.

Methods: Recipients' perioperative data were prospectively collected and evaluated. Postoperative and specific complications, stay in the intensive and intermediate care unit, and the mortality rate with cause of death were analyzed.

Result: Most recipients were classified as Child C (46%). For the patients who underwent LTx for the first time, alcoholic (22%) and viral (21%) cirrhosis and hepatocellular carcinoma (15%) were the prevalent indications. The overall median warm ischemia time, anastomosis duration, and operative time were 47, 108, and 325 minutes, respectively. The median intraoperative blood loss was 2000 ml. A venovenous bypass was never needed to maintain hemodynamic stability. Only in a few cases temporary inferior vena cava clamping was necessary. Most prominent surgical complications were hemorrhage, hematoma, and wound dehiscence. Renal failure occurred in 8.1% of patients. The overall median stay in the intensive and intermediate care unit was 16 days. The mortality rates within 30 and 90 days were 6% and 14%, respectively. Only one technique-related death occurred.

Conclusion: The MPB technique by Belghiti is a feasible and simple LTx technique. The caval flow is preserved during the anhepatic phase, and this minimizes the need for venovenous bypass or portocaval shunt. This technique requires only 1 caval anastomosis, which is easy to perform with a short anhepatic phase. To minimize the risk of outflow obstruction, attention should be paid by doing a wide cavocavostomy cranially to the donor inferior vena cava in a door-lock manner. This technique can be applied in almost all patients undergoing LTx for the first time and liver retransplantation as well.