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. 2020 Dec 15;7(1):e639.
doi: 10.1097/TXD.0000000000001095. eCollection 2021 Jan.

A Novel Surgical Technique to Assure Donor and Recipient Safety: Pyloric to Segment 4 Arterial Reconstruction

Andres Fraile  1 , Luis M Mercado  1 , Hugo Paladini  2 , Diego A Ramisch  1 , Valeria Descalzi  3 , Silvina Yantorno  3 , Pablo A Farinelli  1 , Pablo Barros Schelotto  1 , Gabriel E Gondolesi  1
Affiliations

A Novel Surgical Technique to Assure Donor and Recipient Safety: Pyloric to Segment 4 Arterial Reconstruction

Andres Fraile et al. Transplant Direct. .

Abstract

Background: Strategies to extend the pool of organs include and promote the use of segmental liver grafts. While performing a living donor left lateral segment (LLS) liver transplant and in split procedures, the hepatic artery´s division becomes critical when a dominant segment 4 artery (S4A) emerges from the left hepatic artery (LHA). We aim to describe a novel technique that consists of performing microsurgical reconstruction from the pyloric artery (PA) to S4A.

Case reports: A 45-y-old living donor was evaluated to use his LLS as a graft for a pediatric recipient. During the procedure, a dominant S4A born from the LHA was dissected. To obtain an appropriate LHA length and diameter for the recipient, it was necessary to transect it. An extended right lobe split graft was used in a 61-y-old patient. The S4A born from LHA had to be sectioned during the split procedure. In both cases, segment 4 remained incompletely perfused. The PA was dissected with enough length to be rotated, to perform a microsurgical anastomosis to the S4A, recovering parenchyma's color and Doppler signal while vascular permeability was demonstrated using CT scan. There was no biliary or cut surface complication.

Conclusions: PA to S4A reconstruction is a simple and novel technique that can be used for LLS and extended right lobe split graft and might contribute to increase donor selection and reduce living donor and recipient S4A-related complications.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Preoperative CT scan of case 1. LHA, left hepatic artery; PHA, proper hepatic artery; RHA, right hepatic artery; S4A, segment 4 artery.
FIGURE 2.
FIGURE 2.
Intraoperative picture of the arterial reconstruction of case 1. LHA Stump, left hepatic artery stump; PA, pyloric artery; PHA, proper hepatic artery; S4A, segment 4 artery.
FIGURE 3.
FIGURE 3.
Postoperative CT scan of case 2. CT, celiac trunk; PA, pyloric artery; PHA, proper hepatic artery; RHA, right hepatic artery; S4A, segment 4 artery.
See this image and copyright information in PMC

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