Detailed Abstract
[E-poster - Liver (Pancreas Disease/Surgery)]
[EP 024] Combined liver transplantation with sleeve gastrectomy: a pioneer case series from Brazil
Orlando TORRES1, Jose Maria MORAES-JUNIOR1, Camila GIRAO1, Eduardo FERNANDES1
1Department of Liver Transplantation and Hepatobiliary Surgery, Presidente Dutra University Hospital, Brazil
Background : Nonalcoholic fatty liver disease (NAFLD) follows the burden of obesity and its metabolic complications with a growing demand, approximately 170% more, for liver transplantation (LT) due to nonalcoholic steatohepatitis (NASH)- related cirrhosis. Sleeve gastrectomy (SG) is the most popular bariatric operation in the United States, with a low rate of complications, short operative time, and no gastrointestinal anastomosis.The aim of this study is to present our initial experience with simultaneous liver transplantation and sleeve gastrectomy.
Methods : Liver transplant combined with sleeve gastrectomy (LTSG) was performed using deceased donors, with six conventional (bicaval reconstruction) and one piggyback technique (preservation of the retro hepatic vena cava). Total hepatectomy was performed with hilum dissection followed by common bile duct transection and ligation of the right and left hepatic arteries. Portal vein (PV) identifcation and exposure of its full extension were done. In patients with PV thrombosis, thromboendovenectomy was done to restore PV patency. Portal vein reconstruction was performed with a running 6.0 prolene suture followed by a classic reperfusion. Arterial anastomosis was done with end-to-end anastomosis with running 7.0 prolene suture, most of the times using a “carrel patch” at recipient hepatic artery and gastroduodenal artery confuence.
Results : During an 18-month period, seven patients, four male (57.1%) and three females, were submitted to a combined LTSG with a Roux-en-Y biliary reconstruction. Mean recipient age was 60.5 years, body mass index (BMI) ranged from 33.4 to 45.6 kg/m2 (mean 38.2 kg/m2 ), MELD (model for end-stage liver disease) score ranged from 18 to 29 points (mean 25 points). The indication for LT was NASH with hepatocellular carcinoma, hepatitis C with HCC, pure NASH and alcoholic liver cirrhosis with HCC.
Conclusions : Simultaneous LTSG was an attractive and efective strategy to treat patients with end-stage liver disease associated with morbid obesity.
Methods : Liver transplant combined with sleeve gastrectomy (LTSG) was performed using deceased donors, with six conventional (bicaval reconstruction) and one piggyback technique (preservation of the retro hepatic vena cava). Total hepatectomy was performed with hilum dissection followed by common bile duct transection and ligation of the right and left hepatic arteries. Portal vein (PV) identifcation and exposure of its full extension were done. In patients with PV thrombosis, thromboendovenectomy was done to restore PV patency. Portal vein reconstruction was performed with a running 6.0 prolene suture followed by a classic reperfusion. Arterial anastomosis was done with end-to-end anastomosis with running 7.0 prolene suture, most of the times using a “carrel patch” at recipient hepatic artery and gastroduodenal artery confuence.
Results : During an 18-month period, seven patients, four male (57.1%) and three females, were submitted to a combined LTSG with a Roux-en-Y biliary reconstruction. Mean recipient age was 60.5 years, body mass index (BMI) ranged from 33.4 to 45.6 kg/m2 (mean 38.2 kg/m2 ), MELD (model for end-stage liver disease) score ranged from 18 to 29 points (mean 25 points). The indication for LT was NASH with hepatocellular carcinoma, hepatitis C with HCC, pure NASH and alcoholic liver cirrhosis with HCC.
Conclusions : Simultaneous LTSG was an attractive and efective strategy to treat patients with end-stage liver disease associated with morbid obesity.
SESSION
E-poster
E-Session 03/21 ALL DAY