Abstract:
Accurate dissection of the hepatoduodenal ligament in
the recipient is vital for the success of liver transplantation
surgery. High incidence of anatomic variations
at the hepatic artery, portal vein and biliary ducts in the hepatoduodenal ligament is well known. Surgical
experience is important to be able to foresee the most
common anatomic diversities and the possible variations,
in order to make a safe and accurate dissection
in the hepatic hilum. Before anastomosis, all these
hilar structures must be well identified, safely dissected
and must also have a sufficient length for the coming
implantation process. At the beginning of our program,
we were starting the hepatic hilum dissection close to
the liver. In time, however, we modified our surgical
technique, preferring to start further away from the
liver (closer to the duodenum). This length increased
progressively over 1500 liver transplantations (80%
living donor liver transplantation). During this process,
our main purpose was the early control of the hepatic
artery (artery first approach). In this paper, our aim
is to share our latest version of the hepatoduodenal
ligament dissection technique. We also describe alternative
approaches used in extraordinary situations.
