Fonseca-Neto Olival Cirilo Lucena da, Amorim Américo Gusmão, Rabelo Priscylla, Lima Heloise Caroline de Souza, Melo Paulo Sérgio Vieira de, Lacerda Cláudio Moura
University Hospital Oswaldo Cruz, Faculty of Medical Sciences of Pernambuco, University of Pernambuco, Recife, PE, Brazil.
Arq Bras Cir Dig. 2018 Aug 16;31(3):e1389. doi: 10.1590/0102-672020180001e1389.
Liver transplant (LT) is the only effective and long-lasting option for patients with end-stage liver disease. Innovations and refinements in surgical techniques occurred with the advent of transplants with partial grafts and laparoscopy. Despite these modifications, the abdominal incision remains with only few changes.
Demonstrate the experience with the upper midline incision in LT recipients with whole liver grafts from deceased donors.
Retrospective study with patients submitted to LT. Data were collected from the recipients who performed the surgical procedure through the upper midline incision.
The upper midline incision was used in 20 LT, 19 of which were performed in adult recipients. The main cause was liver disease secondary to alcohol. Male, BMI>25 kg/m² and MELD greater than 20 were prevalent in the study. Biliary complications occurred in two patients. Hemoperitoneum was an indication for reoperation at one of the receptors. Complication of the surgical wound occurred in two patients, who presented superficial surgical site infection and evisceration (omental). Two re-transplant occurred in the first postoperative week due to severe graft dysfunction and hepatic artery thrombosis, which were performed with the same incision, without the need to increase surgical access. There were two deaths due to severe graft dysfunction after re-transplant in 72 h and respiratory sepsis with multiple organ dysfunction in the third week.
The upper midline incision can be safely used in LT recipients with whole grafts from deceased donors. However, receptor characteristics and hepatic graft size should be considered in the option of abdominal surgical access.
肝移植（LT）是终末期肝病患者唯一有效且持久的治疗选择。随着部分肝移植和腹腔镜移植技术的出现，手术技术不断创新和改进。尽管有这些改进，但腹部切口变化不大。
展示在接受来自已故供体的全肝移植的LT受者中采用上腹部正中切口的经验。
对接受LT的患者进行回顾性研究。数据收集自通过上腹部正中切口进行手术的受者。
20例LT采用了上腹部正中切口，其中19例在成年受者中进行。主要病因是酒精性肝病。研究中男性、BMI>25 kg/m²和终末期肝病模型（MELD）评分大于20较为常见。两名患者发生了胆道并发症。一名受者因腹腔积血而再次手术。两名患者出现手术伤口并发症，表现为手术部位浅表感染和网膜脱出。术后第一周因严重移植物功能障碍和肝动脉血栓形成进行了两次再次移植，均通过同一切口进行，无需扩大手术入路。有两例死亡，一例在再次移植后72小时因严重移植物功能障碍死亡，另一例在第三周因呼吸性败血症伴多器官功能障碍死亡。
上腹部正中切口可安全用于接受来自已故供体全肝移植的LT受者。然而，在选择腹部手术入路时应考虑受者特征和肝移植物大小。
