Hepatic artery reconstruction in living donor liver transplantation using surgical loupes: Achieving low rate of hepatic arterial thrombosis in 741 consecutive recipients—tips and tricks to overcome the poor hepatic arterial flow

Background: The reconstruction of hepatic artery (HA) is most complex step in living donor liver transplantation (LDLT) due to smaller diameter of the artery and increased risk of HA related complications. Due to smaller diameter of the HA, many centres use microsurgical technique with interrupted sutures for arterial anastomosis. Aim of our study was to retrospectively investigate the outcomes after HA reconstruction performed under magnifying loupes using “parachute technique”. Materials and Methods: From August 2002 to 31st August 2016, LDLT was performed in 766 recipients. HA reconstruction for initial 25 LDLT surgeries was performed using microsurgery technique (Era I). From May 2007 till date, HA reconstruction was performed in 741 recipients by a “parachute technique” under surgical loupes (Era II). Results: HA reconstruction was performed using surgical loupes in 737 adults (Male:Female, 526:211) and 4 pediatric patients (Male:Female, 3:1). Average diameter of the donor graft HA was 2.8 mm (range,1 to 6.5 mm). The most notable factor in this era was quick HA anastomosis procedure with a mean time of 10 ± 5 minutes (range, 5-30 minutes). In Era II, nine patients (1.21%) developed hepatic artery thrombosis (HAT) whereas 2 patients developed non-thrombotic HA related complications. Extra-anatomic HA reconstruction was performed in 14 patients due to either primary HA anastomosis failure or poor caliber recipient HA. Conclusions: Use of magnifying surgical loupes to perform HA reconstruction is safe, feasible, and yields low incidence of HA related complications. The “Parachute Technique” for HA reconstruction can achieve a speedy reconstruction without increasing risk of HAT. This article is protected by copyright. All rights reserved.