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Subash Gupta,Rajasekhar Kandagaddala,Shaleen Agarwal,Rajesh Dey,Selvakumar Naganathan,Peeyush Varshney,Nilesh Patil 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.4
Backgrounds/Aims: In living donor hepatectomy, hepatic duct division is a crucial step and often a technical challenge, with the aim of obtaining a good hepatic duct for anastomosis in the recipient and an adequate stump in the donor for closure. Very rarely, after duct division, the remaining stump may not be adequate for primary closure. In such a difficult situation, the options would be either to close stump transversely or a Roux-en-Y Hepaticojejunostomy. Methods: We describe a novel surgical technique of “Cystic duct patch repair”, utilizing the available local tissues for closure of bile duct wall. Results: Two year follow up of this technique showed satisfactory results with no evidence of stricture and normal liver functions. Conclusions: In living donor hepatectomy, “Cystic duct patch closure” may be used if the post closure cholangiogram is not satisfactory. Although the best method is prevention by ensuring a stump for closure, very rarely this error can occur and can be sorted by cystic duct patch repair.
( Bhargava Ram Chikkala ),( Subash Gupta ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: It has been pointed out that LHA may not be suitable in all cases. This randomized control trial was conducted to assess whether anastomosis with LHA could be carried out in all the assigned cases and whether the outcome was comparable to anastomosis with RHA of the recipient. Methods: Inclusion criteria:·Living related right lobe adult to adult ABO compatible liver transplantation·Patients planned for duct to duct anastomosis·Single artery in donor graft for anastomosis on preoperative imaging Exclusion criteria:·Retransplantation ·Patients with sclerosing cholangitis or far apart ducts requiring two biliary anastomoses or bilioenteric anastomosis as suggested by preoperative imaging·ABO incompatible·Pediatric liver transplant·Multiple arteries Results: The arterial lumen of the recipient and donor arteries, size mismatch was significantly more in the RHA group. (15% Vs 72%, p-value - 0.03). the early morbidity and mortality was similar in both the groups. Late strictures among survivors were noted more commonly in the RHA group (29.7% vs. 22.7%). Bile leak, mortality, and incidence of late-onset biliary strictures were less common in the LHA group, though the difference was not statistically significant. Conclusions: Anastomosis of the graft artery in a right lobe graft with recipient LHA is feasible in the majority of the cases. The use of LHA was associated with fewer biliary complications in the long term as compared to RHA.
Portal vein fenestration: a case report of an unusual portal vein developmental anomaly
Inbaraj Balradja,Bappaditya Har,Ruchi Rastogi,Shaleen Agarwal,Subash Gupta 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.4
Portal vein anatomic variations are common in living donor liver transplantation. Portal vein fenestration, in which a segment of a vessel divides into at least two channels that reunite into a single distal lumen, has not yet been reported in the literature. Failure to identify this anomaly can lead to catastrophic events in donor liver hepatectomy. Herein, we report an unusual portal vein anomaly that was detected intraoperatively in a living liver donor.