T. Inomoto et al., EXPERIENCES OF 120 MICROSURGICAL RECONSTRUCTIONS OF HEPATIC-ARTERY INLIVING-RELATED LIVER-TRANSPLANTATION, Surgery, 119(1), 1996, pp. 20-26
Background. We reviewed 120 microsurgical reconstructions of a hepatic
artery in living related liver transplantation and discussed the prob
lems encountered. Methods. From January 1991 to July 1994 we performed
a series of 105 living related liver transplantations on children wit
h end-stage liver disease. Arterial reconstruction was performed under
the optical field of a continuous room magnification of approximately
10 times with an operating microscope. Results. Twenty-six percent of
the graft arteries were less than 2 mm in diameter: The time required
for an arterial reconstruction was 49.5 +/- 1.8 minutes. In 15 of the
31 cases in which there were two graft arteries, two arterial reconst
ructions were required. The caliber difference between the graft arter
y and the recipient artery in 30 instances was dealt with by cutting a
n undersized artery obliquely (17 instances), by fish-mouth method (10
instances), by end-to-side anastomosis (I instance), or by funnelizat
ion method (2 instances). In one case we performed an intimal dissecti
on of a recipient hepatic artery and substituted a splenic artery. con
sequently, hepatic arterial thrombosis occurred in only two cases (1.7
%). Conclusions. Microsurgical technique has overcome the high risk of
hepatic arterial thrombosis in cases of fine graft arteries, enabled
the reconstruction of arteries with caliber difference, and decreased
arterial complications with its delicate manipulation.