The role of intraoperative ultrasonography in detection of hepatic vein variations in living donor liver transplantation

Abstract

Background With advances in surgical techniques and immunosuppression, liver transplantation has become the most effective treatment of acute and chronic liver failures. Evaluation of vascular anatomy and detection of hepatic vascular variations prior to surgery, especially transplantation surgery, can help reduce complications in both the donor and the recipient. Intraoperative ultrasonography (IOUS) is known to be beneficial during planning of the transplantation surgery, and can help direct the surgery itself. Objectives To our knowledge, there are no existing studies that evaluate the number and diameter of segment 5 and 8 branches that need to be anastomosed with IOUS. Patients and methods In this study, considering surgical anatomical evaluation as the gold standard, IOUS findings were compared to computed tomography angiography (CTA) findings. 40 patients were included in the study. Results The average diameters of segment 8 branches that were anastomosed and not anastomosed were significantly different when measured by IOUS (p = 0.016); however, no such statistically significant difference was found in measurements made with CTA (p = 0.89). Conclusion CTA is superior to IOUS in detecting segment 5 and 8 veins draining into the middle hepatic vein. However, IOUS is more accurate in predicting which vessels are going to be anastomosed. For a complete and accurate assessment, both imaging modalities should be used to complement each other, and their respective advantages and disadvantages should be known.