Obed Doha, Jarrad Anwar, Othman Mohammad Ibrahim, Siyam Mahmoud, Bashir Abdalla, Obed Aiman
Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
Department of Gastroenterology, Jordan Hospital, Amman, Jordan.
Ann Med Surg (Lond). 2022 May 18;78:103823. doi: 10.1016/j.amsu.2022.103823. eCollection 2022 Jun.
In an effort to increase donor safety in living donor liver transplantation, the utilization of vascular staplers for the division of the right portal and hepatic veins in patients undergoing right lobe liver donation for living donor liver transplantation (LDLT) was implemented. In here we report our experience with vascular staplers in patients undergoing LDLT and evaluate the subsequent feasibility and safety for donors.
17 cases of living donor liver transplant were retrospectively analyzed. The right portal vein was transected directly at the bifurcation of the main portal vein, the right hepatic vein was resected directly at the wall of the inferior vena cava using a vascular stapler device.
We registered a complication rate of 41.2% (7 donors). According to the Clavien-Dindo classification, grade II and grade III complications were each observed in 5.9% and grade IIIb complications in 29.4%, whereas catastrophic bleeding, complications with residual disability or the necessity of re-laparatomy did not occur. Upon 6 weeks, all donors were able to return to their previous occupation in fully recovered condition.
The utilization of vascular staplers in donors during open LDLT presents an encouraging alternative to manual over-sewing of vascular stumps. Apart from its timesaving aspect, the technique reduces the potential risk of life-threatening clamp slippage with subsequent uncontrolled blood loss.
为提高活体肝移植供体的安全性，在活体肝移植（LDLT）右半肝供肝的患者中，采用血管吻合器离断右门静脉和肝静脉。在此，我们报告我们在LDLT患者中使用血管吻合器的经验，并评估其对供体的可行性和安全性。
回顾性分析17例活体肝移植病例。使用血管吻合器装置在门静脉主干分叉处直接横断右门静脉，在下腔静脉壁处直接切除右肝静脉。
我们记录的并发症发生率为41.2%（7例供体）。根据Clavien-Dindo分类，Ⅱ级和Ⅲ级并发症各占5.9%，Ⅲb级并发症占29.4%，而未发生灾难性出血、残留残疾并发症或再次开腹手术的必要性。6周后，所有供体均能完全康复并恢复原工作。
在开放式LDLT中，供体使用血管吻合器是手动缝合血管残端的一种令人鼓舞的替代方法。除了节省时间外，该技术还降低了危及生命的夹子滑脱及随后失控失血的潜在风险。
