The ping-pong ball as a surgical aid in liver transplantation

Liver transplantation using split adult segmental grafts in infants can be a technical challenge because the small abdominal cavity cannot comfortably accommodate the graft, leading to compression. This size mismatch can be a particularly difficult problem when the anteroposterior diameter of the graft is greater than the infant's available anteroposterior peritoneal space. We describe a simple and novel technique that may prevent this complication.

Two infants with biliary atresia weighing 5 kg each and aged 6 and 5 months, received split adult liver left lateral segment transplants from deceased donors weighing 55 and 65 kg, respectively. Congestion of the graft and inadequate perfusion were prevented by placing a sterilized ping-pong ball in the retrohepatic space to elevate the graft off the native hepatic fossa. The bilateral subcostal incision was required to be extended vertically in the midline up to the xiphisternum in both patients to enlarge the abdominal cavity. Delayed closure of the wound was performed after 5 days using Surgisis (porcine small intestine submucosa, Cook Surgical Inc, Bloomington, IN) when it was possible to remove the ping-pong ball in one of the patients. Both patients have recovered well from the transplant. A follow-up of 1 year in the patient with the in situ ping-pong ball shows it to be well anchored and causing no symptoms.

In children undergoing large-for-size split liver grafts, delaying the closure of the abdominal wound along with elevation of the graft using a ping-pong ball can be a useful and simple adjunct to prevent the complications of graft compression.