A New Secured Technique for Suprahepatic Vena Caval Anastomosis in Porcine Liver Transplantation

It is well recognized that hemorrhage or kinking of the suprahepatic vena caval anastomosis is the most fatal complication apparent within 24 hr after orthotopic liver transplantation in the pig. A secured technique for suprahepatic vena caval anastomosis is described in detail herein. Our technique include (1) the use of a diaphragmatic cuff, (2) the closure of phrenic vein orifices using transfixation technique, and (3) the application of "stay-suture" in the orifice of right phrenic vein. This technique has added significantly to the strength of the suprahepatic vena caval anastomosis, and there has been no experiences of uncontrollable bleeding and kinking of suprahepatic vena caval anastomosis in 48 porcine orthotopic transplants of the liver. In conclusion, we believe that this technique described herein is a simplified and secured method to avoid the hemorrhage and kinking of suprahepatic anastomosis in porcine liver transplantation

Improved Techniques for Orthotopic Liver Transplantation in Pigs: A preliminary study

Orthotopic liver transplantations were performed on 12 pigs between November, 1986 and February, 1987. Survivals and causes of death were assessed according to the type of surgical procedure employed. Six operations were carried out according to the original procedure of Terblanche et al, whereas for other six animals, the transplantation was conducted by our modified procedure in which cannulation was made into the splenic vein without splenectomy at the veno-venous (v-v) bypass and a diaphragmatic cuff was used for the anastomosis of suprahepatic vena cava. 1/6 animals with original procedure and 5/6 with our modified procedure survived for more than 7 days. The total ischemic time was significantly short in the group subjected to the modified procedure. The major cause of death in the group on which the original procedure was conducted was gastric ulceration, accounting for 67% of the mortality, whereas in the modified procedure group, the mortality rate was reduced significantly to 17%. This operative technique has provided excellent survival rates in our transplanted animals