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- 저자 : ( Selvakumar Naganathan ) (검색결과 2 건)
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( Naganathan Selvakumar ),( Selvakumar Naganathan ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Hepatic artery intimal dissection (HAD) followed by hepatic artery thrombosis (HAT) is serious complication of liver transplantation. There is paucity of information in literature on the management options for HAD encountered during surgery. In this study we describe a new classification and technique for the management of HAD during living donor liver transplant (LDLT). Methods: Based on the longitudinal extent of intimal dissection, HAD was classified into 4 types. Management was based on the availability of adequate length of hepatic artery and availability of alternate source of inflow. The dissected hepatic artery itself was used for arterial anastomosis in cases with preserved flow in the dissected artery and paucity of an alternative sources of arterial inflow. The technique of using the dissected artery is based on close approximation of tunica intima to media with the first two sutures of the arterial anastomosis. Patients with HAD were compared with those without HAD for evaluation of risk factors for intimal dissection. Results: 47 (2.4%) patients developed HAD during surgery. 22 (46.7%) patients had type II dissection for whom the other (right or the left) undissected hepatic artery was used for anastomosis. 20 (45%) patients were found to have major (type III or IV) dissection. The dissected artery was used for anastomosis in 9 of (45%) of these patients. Post-operative HAT developed in only one out of the 9 patients. Pre-existing portal vein thrombosis (PVT) and prior trans arterial embolization (TAE) were found to be major risk factors for development of intimal dissection. Conclusions: Classification
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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.
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