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World J Transplant. Jun 24, 2016; 6(2): 272-277
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.272
Hepatoduodenal ligament dissection technique during recipient hepatectomy for liver transplantation: How I do it?
Cuneyt Kayaalp, Kerem Tolan, Sezai Yilmaz
Cuneyt Kayaalp, Kerem Tolan, Sezai Yilmaz, Liver Transplantation Institute, Turgut Ozal Medical Center, Inonu University, 44315 Malatya, Turkey
Author contributions: Kayaalp C performed the procedure; Kayaalp C, Tolan K and Yilmaz S contributed to writing, editing and revising of this paper.
Conflict-of-interest statement: The authors declare no conflict of interest regarding our manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cuneyt Kayaalp, MD, Professor, Liver Transplantation Institute, Turgut Ozal Medical Center, Inonu University, Elazig Cad, 44315 Malatya, Turkey. cuneytkayaalp@hotmail.com
Telephone: +90-422-3410660 Fax: +90-422-3410229
Received: October 20, 2015
Peer-review started: October 21, 2015
First decision: December 28, 2015
Revised: April 2, 2016
Accepted: April 14, 2016
Article in press: April 18, 2016
Published online: June 24, 2016
Processing time: 247 Days and 3.9 Hours
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.

Keywords: Liver transplantation; Living donor liver transplantation; Surgical technique

Core tip: The hepatic artery is one of the main components of the hepatoduodenal ligament and exhibits high anatomic variability, which may change the outcome and success of liver transplantation. In our experience, early control of the hepatic artery (artery first approach) and by the guidance of the hepatic artery, dissection of the rest of the hepatoduodenal ligament components is more practical. In this paper, we share our latest version of the hepatoduodenal ligament dissection technique, developed over the course of 1500 liver transplantations (80% living donor liver transplantation) in our clinic.