[Bisection of the liver for transplantation. Simplification of the method]

Blind bipartition of a whole liver to obtain two transplants is problematic, because of frequent vasculo-biliary duplications, especially arterial (mainly on the left) and biliary (mainly on the right) duplications. Arteriography and cholangiography on the back table are necessary to obtain a map of the arterial and biliary distributions without injuring the vessels of the biliary ducts enclosed in the vasculo-biliary sheaths. The surgeon may use three special maneuvers: resection of segment IV when the arterio-biliary duplication involves segment IV; attribution of the common hepatic artery on the side of the arterial duplication (frequent on the left); attribution of a short segment of the common hepatic duct on the side of a biliary duplication (frequent on the right). In an anatomical study of 93 vasculo-biliary casts, the following results were obtained: in 4 cases: bipartition not possible; in 22 cases: "ideal" bipartition (no duplication); in 57 cases: partition right-left livers: in 37 cases 1 maneuver, in 19 cases 2 maneuvers, in 1 case 3 maneuvers; in 10 cases: partition right liver-left lobe: in 2 cases 1 maneuver, in 8 cases 2 maneuvers. We report 8 bipartitions and 16 transplantations (10 children and 6 adults). The duplications we noted do not differ statistically from those reported in our former anatomical study. Survival of the patients (100% in usual cases, 66% in case of extreme emergency or terminal hepatic insufficiency) and survival of the transplants (68,75%) do not differ either from those noted in other transplantation methods. Complications, especially arterial thrombosis, were within the same statistical ranges.(ABSTRACT TRUNCATED AT 250 WORDS)