Detailed Abstract
[Liver Video Exhibition - Liver (Others (ERAS, Education etc.))]
[LV VE 7] SUCCESSFUL ROBOTIC CLOSURE OF a FORGOTTEN SPONTANEOUS SPLENO-RENAL SHUNT FOLLOWING LIVER RETRANSPLANTATION CAUSING HYPERAMMONEMIA AND SIGNS OF LIVER FAILURE.
Luigi RESCIGNO 1, Emanuela Maria LO BIANCO 1, Gianluca ROMPIANESI 1, Gianluca CASSESE 1, Silvia CAMPANILE 1, Mariano Cesare GIGLIO 1, Roberto MONTALTI 1, Roberto Ivan TROISI 1
1 Minimally Invasive And Robotic HPB Surgery, Federico II University, ITALY, ITALY
Background : While closure of a spontaneous porto-systemic shunt may be controversial in small-for-size liver transplantation, it is considered a necessity in whole liver transplantation (LTx) to avoid hepatofugal portal flow.
Methods : A 59 y.o. years old male patient with history of PSC received a LTx in 2001. Due to a chronic rejection, a second LTx was needed in 2021. However, shortly after, signs of encephalopathy occurred. An initial opinion was to retransplant again the patient, however, the liver biopsy was normal and a carefull evaluation of the CT showed a patent SSRS, probably the reason of the symptoms. HVPG gradient before and after temporary shunt closure were 6 and 11 mmHg. Attempts to embolize the SSRS failed. The patient was then referred to another center where the indication for a surgical robotic-assisted closure of the shunt was placed.
Results : Following extensive adhesiolysis, the anterior liver surface was freed allowing an initial check with IOUS showing a mean velocity of 2 cm/sec. The transmesenteric approach was used to reach the SSRS. Fenestrated bipolar and Maryland forceps were used to carefully dissect the fat tissue in that regio. A bulldog clamp was positioned on the SSRS. The portal flow rose up to 7 cm/sec; the shunt was secured with a vascular stapler. No more encephalopathy was recorded and the SSRS is closed 1 year after the procedure.
Conclusions : SSRS may worsen the metabolic function of good allograft. The robotic closure could be an alternative to facilitate the surgical ligation despite iterative surgeries.
Methods : A 59 y.o. years old male patient with history of PSC received a LTx in 2001. Due to a chronic rejection, a second LTx was needed in 2021. However, shortly after, signs of encephalopathy occurred. An initial opinion was to retransplant again the patient, however, the liver biopsy was normal and a carefull evaluation of the CT showed a patent SSRS, probably the reason of the symptoms. HVPG gradient before and after temporary shunt closure were 6 and 11 mmHg. Attempts to embolize the SSRS failed. The patient was then referred to another center where the indication for a surgical robotic-assisted closure of the shunt was placed.
Results : Following extensive adhesiolysis, the anterior liver surface was freed allowing an initial check with IOUS showing a mean velocity of 2 cm/sec. The transmesenteric approach was used to reach the SSRS. Fenestrated bipolar and Maryland forceps were used to carefully dissect the fat tissue in that regio. A bulldog clamp was positioned on the SSRS. The portal flow rose up to 7 cm/sec; the shunt was secured with a vascular stapler. No more encephalopathy was recorded and the SSRS is closed 1 year after the procedure.
Conclusions : SSRS may worsen the metabolic function of good allograft. The robotic closure could be an alternative to facilitate the surgical ligation despite iterative surgeries.
SESSION
Liver Video Exhibition
Video Exhibition 3/21/2024 12:00 AM - 12:00 AM