Temporary Right Portocaval Shunt During Piggyback Liver Transplantation.

Abstract

During piggyback liver transplantation (LT), a temporary end-to-side portocaval anastomosis (PCA) facilitates native total hepatectomy while maintaining hemodynamic stability. Some argue that PCA, performed on the main portal trunk (PT), might shorten the main portal vein and could cause technical difficulties during LT. We describe a temporary PCA performed on the right portal vein (R-PCA). The technique entails complete dissection of the main portal trunk up its right and left branches. After having ligated the left portal vein, the right is anastomosed end-to-side to the anterior face of the inferior vena cava. Taken down of R-PCA, before graft-recipient portal vein anastomosis, is achieved by stapling or suturing. An R-PCA has been performed in 14 over 15 planned procedures at our unit. In one case, because of intraoperative difficulties the PCA was performed on the PT. A temporary R-PCA represents a feasible alternative method of portal decompression during LT. Its use can be implemented into the technical armamentarium of transplant surgeons.