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Sterno-laparotomy and extracorporeal circulation for liver transplantation after repeat-surgery for Budd-Chiari
T Carrel1, R Schlumpf, F Lagardièr
1Department of Surgery, University Hospital, Zürich, Switzerland.
Insights
This study details successful living donor liver transplantation for Budd-Chiari syndrome. A novel atrioatrial anastomosis during cardiopulmonary bypass simplified the procedure and reduced blood loss in complex cases.
Area of Science:
- Hepatology
- Transplant Surgery
- Vascular Surgery
Background:
- Budd-Chiari syndrome is a rare hepatic vascular disease often leading to liver failure.
- Previous surgical interventions like mesenteriocaval shunts may not prevent disease progression.
- Living donor liver transplantation is a viable option for end-stage liver disease due to Budd-Chiari syndrome.
Observation:
- Two patients with Budd-Chiari syndrome, previously treated with mesenteriocaval shunts and transcaval liver resection, presented with deteriorating liver function and portal hypertension.
- The patients required liver transplantation due to recurrent bleeding and advanced liver disease.
- The surgical approach involved a sternolaparotomy and construction of an atrioatrial anastomosis.
Findings:
- Liver transplantation was successfully performed in both patients.
- Utilizing cardiopulmonary bypass for atrioatrial anastomosis simplified the surgical technique.
- This approach significantly reduced intraoperative blood loss.
Implications:
- This surgical strategy offers a potentially improved method for managing complex Budd-Chiari syndrome cases requiring liver transplantation.
- The simplified anastomosis technique may enhance patient outcomes and reduce surgical risks.
- Further research into this technique could refine surgical management protocols for hepatic vascular diseases.
Abstract:
The surgical management of two patients undergoing living transplantation for Budd-Chiari syndrome is reported. Mesenteriocaval shunt had previously been performed in both cases, followed by transcaval liver resection and hepatoatrial anastomosis after 3 and 5 years, respectively. Liver transplantation was necessitated by deteriorating liver function with portal hypertension and recurrent bleeding. The successful operation was performed via sternolaparotomy. Atrioatrial anastomosis was constructed during cardiopulmonary bypass, considerably simplifying the technical procedure and dramatically reducing blood loss.