Splitting livers: Trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Surgical techniques

Background:

• Debate exists regarding optimal liver splitting techniques: classical (Segment IV division) versus umbilical fissure division.
• Current practice varies among surgical teams without clear evidence-based guidelines.

Purpose of the Study:

• To compare the outcomes of left split liver grafts procured using two distinct division techniques: classical versus umbilical fissure.
• To evaluate the impact of division technique on graft quality and post-transplant outcomes.

Main Methods:

• Retrospective analysis of 47 left split liver grafts from a single center.
• Grafts were divided using either the classical technique (N=28) or the umbilical fissure and plate technique (N=19).
• Randomized allocation of recipients and consistent transplantation by a single team.

Main Results:

• No significant differences in demographics, technical aspects, or outcomes were observed between the two groups.
• Grafts from the classical technique group (Group A) more frequently had a single bile duct orifice, but this did not increase biliary complications.
• Both techniques resulted in good quality split grafts with excellent outcomes (96% actual graft survival rate at a median of 26 months).

Conclusions:

• Both classical and umbilical fissure liver splitting techniques produce high-quality grafts with excellent patient outcomes.
• Surgical expertise with a specific technique appears more critical than the technique itself.
• The classical technique may offer greater flexibility and could be preferred by surgeons.