Splitting livers: Trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes.

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Clinical Guidelines
Authored By
de Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P
Authored On
Interests
Gastroenterology
Emergency Medicine
Surgery
Speciality
Gastroenterology
Surgery
Emergency Medicine
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volume
19
ISSN
1399-3046
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{"article_title":"Splitting livers: Trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes.","author":"de Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P","journal_title":"Pediatric transplantation","issn":"1399-3046","isbn":"","publication_date":"2015 Aug","volume":"19","issue":"5","first_page":"517","page_count":"","accession_number":"26059061","doi":"10.1111\/petr.12534","publisher":"Munksgaard","doctype":"Comparative Study","subjects":"Hepatectomy methods; Liver surgery; Liver Transplantation methods; Surgical Procedures, Operative; Adult; Child; Child, Preschool; Databases, Factual; Graft Survival; Humans; Infant; Living Donors; Middle Aged; Retrospective Studies; Tissue and Organ Procurement; Tomography, X-Ray Computed; Treatment Outcome; Umbilicus surgery","interest_area":["Gastroenterology"," Emergency Medicine"," Surgery"],"abstract":"Unlabelled: Controversy remains about the best line of division for liver splitting, through Segment IV or through the umbilical fissure. Both techniques are currently used, with the choice varying between surgical teams in the absence of an evidence-based choice. We conducted a single-center retrospective analysis of 47 left split liver grafts that were procured with two different division techniques: \"classical\" (N = 28, Group A) or through the umbilical fissure and plate (N = 19, Group B). The allocation of recipients to each group was at random; a single transplant team performed all transplantations. Demographics, characteristics, technical aspects, and outcomes were similar in both groups. The grafts in Group A, prepared with the classical technique, were procured more often with a single BD orifice compared with the grafts in Group B; however, this was not associated with a higher incidence of biliary problems in this series of transplants (96% actual graft survival rate [median \ufffd s.d. Follow-Up: 26 \ufffd 20 months]). Both techniques provide good quality split grafts and an excellent outcome; surgical expertise with a given technique is more relevant than the technique itself. The classical technique, however, seems to be more flexible in various ways, and surgeons may find it to be preferable. \ufffd 2015 John Wiley & Sons A\/S. Published by John Wiley & Sons Ltd.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=26059061&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"de Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P","Journal_Info":"Publisher: Munksgaard Country of Publication: Denmark NLM ID: 9802574 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-3046 (Electronic) Linking ISSN: 13973142 NLM ISO Abbreviation: Pediatr Transplant Subsets: MEDLINE","Publication_Type":"Comparative Study; Journal Article","Published_Date":"2015-08-01","Source":"Pediatric transplantation [Pediatr Transplant] 2015 Aug; Vol. 19 (5), pp. 517-26. Date of Electronic Publication: 2015 Jun 09.","Languages":"English","Electronic_ISSN":"1399-3046","MeSH_Terms":"Surgical Procedures, Operative*, Hepatectomy\/*methods , Liver\/*surgery , Liver Transplantation\/*methods, Adult ; Child ; Child, Preschool ; Databases, Factual ; Graft Survival ; Humans ; Infant ; Living Donors ; Middle Aged ; Retrospective Studies ; Tissue and Organ Procurement ; Tomography, X-Ray Computed ; Treatment Outcome ; Umbilicus\/surgery","Subjects":"Adult, Child, Child, Preschool, Databases, Factual, Graft Survival, Humans, Infant, Living Donors, Middle Aged, Retrospective Studies, Tissue and Organ Procurement, Tomography, X-Ray Computed, Treatment Outcome, Umbilicus surgery, Hepatectomy methods, Liver surgery, Liver Transplantation methods, Surgical Procedures, Operative","Title_Abbreviations":"Pediatric transplantation","Volume":"19"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"26059061","RelevancyScore":"786","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"786.407836914063"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=26059061&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=26059061&authtype=shib&custid=ns346513&group=main&profile=eds"}
ISSN
1399-3046
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true
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Additional Info
["de Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P","Publisher: Munksgaard Country of Publication: Denmark NLM ID: 9802574 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-3046 (Electronic) Linking ISSN: 13973142 NLM ISO Abbreviation: Pediatr Transplant Subsets: MEDLINE","Comparative Study; Journal Article","2015-08-01","Pediatric transplantation [Pediatr Transplant] 2015 Aug; Vol. 19 (5), pp. 517-26. Date of Electronic Publication: 2015 Jun 09.","English","1399-3046","Surgical Procedures, Operative*, Hepatectomy\/*methods , Liver\/*surgery , Liver Transplantation\/*methods, Adult ; Child ; Child, Preschool ; Databases, Factual ; Graft Survival ; Humans ; Infant ; Living Donors ; Middle Aged ; Retrospective Studies ; Tissue and Organ Procurement ; Tomography, X-Ray Computed ; Treatment Outcome ; Umbilicus\/surgery","Adult, Child, Child, Preschool, Databases, Factual, Graft Survival, Humans, Infant, Living Donors, Middle Aged, Retrospective Studies, Tissue and Organ Procurement, Tomography, X-Ray Computed, Treatment Outcome, Umbilicus surgery, Hepatectomy methods, Liver surgery, Liver Transplantation methods, Surgical Procedures, Operative","Pediatric transplantation","19"]
Description
Unlabelled: Controversy remains about the best line of division for liver splitting, through Segment IV or through the umbilical fissure. Both techniques are currently used, with the choice varying between surgical teams in the absence of an evidence-based choice. We conducted a single-center retrospective analysis of 47 left split liver grafts that were procured with two different division techniques: "classical" (N = 28, Group A) or through the umbilical fissure and plate (N = 19, Group B). The allocation of recipients to each group was at random; a single transplant team performed all transplantations. Demographics, characteristics, technical aspects, and outcomes were similar in both groups. The grafts in Group A, prepared with the classical technique, were procured more often with a single BD orifice compared with the grafts in Group B; however, this was not associated with a higher incidence of biliary problems in this series of transplants (96% actual graft survival rate [median ± s.d.<br />Follow-Up: 26 ± 20 months]). Both techniques provide good quality split grafts and an excellent outcome; surgical expertise with a given technique is more relevant than the technique itself. The classical technique, however, seems to be more flexible in various ways, and surgeons may find it to be preferable.<br /> (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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