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

Öz

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.

Anahtar Kelimeler

• 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?

Öz

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.

Anahtar Kelimeler

• Karaciğer nakli,Gastroduodenal arter ligasyonu,safra yolu komplikasyonu

Kaynakça

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