DOES THE LIGATION OF GASTRODUODENAL ARTERY PERFORMED AT ARTERIAL STEAL SYNDROME IN LIVING DONOR LIVER TRANSPLANTATION CAUSE COMPLICATIONS IN DUCT-TO-DUCT BILIARY ANASTOMOSIS?

Year 2018, Volume: 32 Issue: 2, 131 - 140, 27.08.2018

Mücahit Özbilgin , Tarkan Ünek Cihan Ağalar Tufan Egeli Serhan Derici , Canan Altay Mesut Akarsu , Sevda Özkardeşler İbrahim Astarcıoğlu

Abstract

Objective: It was aimed to evaluate whether
the ligation of gastroduodenal artery performed for the treatment of arterial
steal syndrome diagnosed during hepatic artery reconstruction in living donor
liver transplantation (LDLT) cause complications in duct-to-duct bile
anastomoses.

Material
and Method: This retrospective cohort study
included patients older than 18 years of age who underwent LDLT and survived
for at least 6 months at the Liver Transplantation Unit of General Surgery
Department in Medical Hospital of Dokuz Eylul University between June 2000 and
July 2017. The patients' demographic data, graft weight, duration of cold
ischemia, Child and MELD scores, immunosuppressive agents they used and the presence
of postoperative biliary complications after the gastroduodenal artery ligation
were investigated.

Results:
Gastroduodenal artery steal syndrome was diagnosed through Doppler
ultrasonography in 11 (4.5%) of 240 patients with LDLT intraoperatively during
hepatic artery reconstruction. Of the biliary anastomoses, 8 (72.7%) were
indent duct-to-duct anastomosis and 3 (27.3%) were Roux-en-Y
Hepaticojejunostomy. The average follow-up time was 3260 (371-4357) days. None
of the 8 patients who underwent duct-to-duct biliary anastomosis developed
biliary tract complication (p <0.001).

Conclusion:
Gastroduodenal artery ligation can be performed safely in the treatment of
arterial steal syndrome in patients with duct-to-duct biliary anastomosis in
LDLT.

Keywords

Liver transplantation, ligation of gastroduodenal artery, bile tract complication

Canlı Vericili Karaciğer Transplantasyonlarındaki Arteryel Çalma Sendromunda Gastroduodenal Arter Ligasyonu, Duct-To-Duct Safra Anastomozlarında Komplikasyonlara Yol Açar mı?

Abstract

Amaç: Canlı
vericili karaciğer transplantasyonlarında (CVKT) hepatik arter rekonstrüksiyonu
esnasında tanı konulan arteryel çalma sendromu’nun  tedavisinde yapılan gastroduodenal arter
ligasyonunun, “duct-to-duct” safra anastomozlarında komplikasyonlara olan
etkisinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Bu
çalışma retrospektif bir kohort çalışmadır. Dokuz Eylül Üniversitesi Hastanesi
Genel Cerrahi Karaciğer Nakli Biriminde Haziran 2000-2017 yıllarında CVKT
yapılan 18 yaşından büyük ve en az 6 ay sağ kalımı olan hastalar çalışmaya
dahil edildi. Hastaların demografik verileri, greft ağırlığı, soğuk iskemi
süreleri, Child ve MELD skorları, kullandıkları immünossüpresif ajanlar ve
duct-to-duct safra anastomozu yapılan olgularda gastroduodenal arter ligasyonu
sonrası postoperatif biliyer komplikasyonların ortaya çıkıp çıkmadığı
incelendi.

Bulgular: CVKT
yapılan 240 hastanın hepatik arter rekonstrüksiyonu esnasında intraoperatif
olarak 11’inde (%4,5) Doppler Ultrasonografi ile gastroduodenal arter çalma
sendromu tanısı konuldu. Hastaların safra yolu anastomozları; 8(%72,7)’inde duct-to-duct
anastomoz ve 3(%27,3)’ünde Roux-en-Y Hepatikojejunostomi şeklindeydi. Ortalama
izlem süresi 3260 (371-4357) gündü. Takiplerinde duct-to-duct safra yolu
anastomozu yapılan 8 olgunun hiç birisinde safra yolu komplikasyonu gelişmediği
görüldü (p<0,001).

Sonuç: CVKT’larında
safra yolu devamlılığı “duct-to-duct” şeklinde olan hastalarda arteriyel çalma
sendromu’nun tedavisinde gastroduodenal arter ligasyonu güvenle yapılabilir.

Keywords

Karaciğer nakli, Gastroduodenal arter ligasyonu, safra yolu komplikasyonu

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