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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_682_Библиотеки_им_академика_М_И_Перельмана.pdf
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Fig. 11.3 Incision of the anterior wall of the native inferior vena cava
11 Auxiliary Orthotopic Liver Transplantation forFulminant Hepatitis
Fig. 11.4 Posterior wall of the side-to-side cavo-caval anastomosis
Fig. 11.6 Lateral clamping of the native portal vein
Fig. 11.7 Incision of the anterior wall of the native portal vein
Fig. 11.5 Completion of the side-to-side cavo-caval anastomosis
11 Auxiliary Orthotopic Liver Transplantation forFulminant Hepatitis
99
Fig. 11.8 Posterior wall of the end-to-side anastomosis between the
graft portal vein and the native portal vein
Fig. 11.9 Completion of the end-to-side anastomosis between the
graft portal vein and the native portal vein
Fig. 11.11 End-to-side arterial anastomosis between the graft hepatic
artery and the native splenic artery
Fig. 11.12 Bilio-enteric anastomosis with an external biliary
drainage
Fig. 11.10 Auxiliary whole graft revascularization
Fig. 11.13 The native liver (H45678) and the whole liver graft
(G12345678)
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11 Auxiliary Orthotopic Liver Transplantation forFulminant Hepatitis
Fig. 11.14 The whole liver graft (G12345678) in the left
hypochondrium
Fig. 11.15 Final aspect of the auxiliary whole liver transplantation
Fig. 11.16 Final aspect of the auxiliary whole liver transplantation
Fig. 11.17 Negative wound therapy for the management of difcult
wound closure
References
Fig. 11.18 Post-operative
computed tomography
(1 month)
101
Fig. 11.19 Post-operative
computed tomography after
immunosuppression
withdrawal (12 months)
References
1. Gubernatis G, Pichlmar R, Kemnitz J, Gratz K. Auxiliary partial
orthotopic liver transplantation (APOLT) for fulminant hepatic failure: rst successful case report. World J Surg. 1991;15(5):660–5;
discussion 665–6.
2. Bismuth H, Azoulay D, Samuel D, Reynes M, Grimon G,
Majno P, et al. Auxiliary partial orthotopic liver transplantation for fulminant hepatitis. The Paul Brousse experience.
Ann Surg. 1996;224(6):712–24; discussion 724–6. https://doi.
org/10.1097/00000658- 199612000- 00007.
Management ofLarge-for-Size Liver
Graft Mismatch
12
Liver volume matching in liver transplantation is important.
Advances have been obtained to avoid small-for-size grafts,
but management of large grafts remains a major challenge in
this setting. Consequences include difcult anastomosis,
poor vascular alignment, difcult wound closure, graft compression, and necrosis. Negative wound therapy allows a
rapid closure of abdominal wall and salvage of the graft. In
addition, preservation of the native inferior vena cava using a
large graft during adult whole liver transplantation is associated with potential risk of hepatic venous outow compression/obstruction. Intraoperative placement of materials to
restore adequate hepatic venous outow can overcome this
complication. Placement of inatable materials [1] leads to
gradual deation in the postoperative period, which might
obviate the need for reoperation (Figs.12.1, 12.2, 12.3, 12.4,
12.5, and 12.6).
Fig. 12.1 Large-for-size liver graft Fig. 12.2 Large-for-size liver graft after partial abdominal closure
after partial abdominal closure
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
C. Lim et al., Atlas of Liver Transplantation, https://doi.org/10.1007/978-3-031-85264-0_12
103
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Fig. 12.3 Large-for-size liver graft after partial abdominal closure
12 Management ofLarge-for-Size Liver Graft Mismatch
Fig. 12.5 Negative wound therapy for the management of difcult
abdominal closure
Fig. 12.4 Negative wound therapy for the management of difcult
abdominal closure
Reference
1. Lim C, Osseis M, Tudisco A, Lahat E, Sotirov D, Salloum C,
Azoulay D. Hepatic venous outow obstruction after whole liver
transplantation of large-for-size graft: versatile intra-operative management. Ann Hepatobiliary Pancreat Surg. 2018;22:321–5.
Fig. 12.6 Retro-hepatic placement of breast implants to improve
hepatic vein outow
Temporary Portocaval Shunt
13
During liver transplantation, clamping of the portal vein
induces splanchnic venous congestion and accumulation of
noxious compounds. These adverse effects could increase
ischemia/reperfusion injury and subsequently the risk of
graft dysfunction, especially for grafts harvested from
Fig. 13.1 Lateral clamping of the native infrahepatic inferior vena
cava
extended criteria donors. Temporary portocaval shunt may
prevent these complications and decrease blood loss [1].
This shunt is divided before portal reconstruction (Figs.13.1,
13.2, 13.3, 13.4, 13.5, 13.6, 13.7, 13.8, 13.9, 13.10, 13.11,
and 13.12).
Fig. 13.2 Posterior wall of the end-to-side anastomosis between the
portal vein and the inferior vena cava
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
C. Lim et al., Atlas of Liver Transplantation, https://doi.org/10.1007/978-3-031-85264-0_13
105
106
13 Temporary Portocaval Shunt
Fig. 13.3 Completion of the portocaval shunt
Fig. 13.4 Incision of the anterior wall of the native infrahepatic infe-
rior vena cava
Fig. 13.6 Temporary portocaval shunt
Fig. 13.7 Portal pressure measurement
Fig. 13.5 Posterior wall of the end-to-side anastomosis between the
portal vein and the inferior vena cava
Fig. 13.8 Temporary portocaval shunt
Reference
107
Fig. 13.9 Temporary portocaval shunt
Fig. 13.10 Surgical view of a temporary portocaval shunt after total
hepatectomy
Fig. 13.11 Temporary portocaval shunt using a venous allograft
because the portal vein was too short
Reference
1. Tzakis AG, Reyes J, Nour B, Marino IR, Todo S, Starzl
TE.Temporary end to side portacaval shunt in orthotopic hepatic
transplantation in humans. Surg Gynecol Obstet. 1993;176(2):1802.
Fig. 13.12 Temporary portocaval shunt using an arterial allograft