In split liver transplantation for two adults, the maintenance of an optimal venous outflow is of great importance to safeguard a maximal parenchymal integrity. In principle the same venous reconstructions and anastomoses are made as in right liver donation, including reanastomosis of segment 6 veins and reconstruction of larger segment 5 or 8 veins as shown. Additionally two techniques, not usable in living donation, can be applied to make the implantation easier while maintaining optimal venous outflow.
This technique can be used in the in-situ as well as in the ex-situ technique. The frontand backwall of the vena cava are cut longitudinally, thus obtaining a caval patch on both grafts containing the respective hepatic veins as well as a possible segment 6 vein on the right side and Sg1 veins on the left side. At implantation the caval patches are sewn into the front wall of the preserved recipient vena cava.
Splitting of the Middle Hepatic Vein
This technique can only be performed in ex-situ splitting. During parenchymal transection the middle hepatic vein is cut through the middle, in continuity with its orifice in the vena cava (A). On both sides it is reconstructed using donor iliac vein patches. In this way larger segment 5 or 8 veins are drained without the need for any further reconstructions or anastomoses (B-1,B-2).
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