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UPPER MIDLINE INCISION IN RECIPIENTS OF DECEASED-DONORS LIVER TRANSPLANTATION.

Olival Cirilo Lucena da Fonseca-Neto1, Américo Gusmão Amorim1, Priscylla Rabelo1

  • 1University Hospital Oswaldo Cruz, Faculty of Medical Sciences of Pernambuco, University of Pernambuco, Recife, PE, Brazil.

Arquivos Brasileiros De Cirurgia Digestiva : ABCD = Brazilian Archives of Digestive Surgery
|August 23, 2018
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Summary

The upper midline incision is a safe approach for liver transplants (LT) using whole grafts from deceased donors. Careful consideration of patient factors and graft size is recommended for optimal surgical access in LT procedures.

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Area of Science:

  • Hepatology
  • Transplant Surgery
  • Surgical Incisions

Background:

  • Liver transplantation (LT) is the definitive treatment for end-stage liver disease.
  • Surgical techniques for LT have evolved, but abdominal incisions remain largely unchanged.
  • Innovations include partial grafts and laparoscopic approaches.

Purpose of the Study:

  • To evaluate the safety and efficacy of the upper midline incision in liver transplant recipients.
  • To document the surgical experience with this incision in adult patients receiving whole liver grafts from deceased donors.

Main Methods:

  • Retrospective study design.
  • Data collected from liver transplant recipients who underwent surgery using an upper midline incision.
  • Analysis of patient characteristics, surgical outcomes, and complications.

Main Results:

  • The upper midline incision was utilized in 20 liver transplants (LT), primarily in adult males with alcohol-related liver disease and high MELD scores.
  • Complications included two biliary issues, one hemoperitoneum requiring reoperation, and two surgical wound complications (infection, evisceration).
  • Two re-transplants were performed using the same incision; two patient deaths occurred due to graft dysfunction and sepsis.

Conclusions:

  • The upper midline incision is a viable and safe option for liver transplantation with whole grafts from deceased donors.
  • Patient characteristics and graft size are crucial factors to consider when selecting the abdominal surgical approach for LT.