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Omental Flap for Hepatic Artery Coverage During Liver Transplantation

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Journal of Gastrointestinal Surgery

Abstract

In 1994, a technique of omental flap interposition to cover the celiac and mesenteric vessels after pancreaticoduodenectomy was described. It aimed to isolate the pancreatic anastomosis from the vessels dissected during pancreaticoduodenectomy. In liver transplantation (LT), the omental flap was initially used to reduce the risk of hepatic artery (HA) kinking. Currently, we use this technique to cover the dissected HA, reducing the consequences of postoperative biliary fistula (BF), particularly the risk of postoperative complications (thrombosis/bleeding). We describe this technique adding a simple modification consisting of covering the HA with an omental flap after completion of the biliary anastomosis. We performed LT with an omental flap to cover the HA vessels in 62 (55 %) of the 112 consecutive patients who underwent LT between January 2012 and July 2013. No postoperative deaths occurred. The rate of BF was 9.7 % (six cases). In the omental flap series, no postoperative thrombosis, HA pseudoaneurysm, or complications occurred. In the six cases of BF, the dissected HAs were completely isolated from the biloma. This simple technique has no specific morbidity; it isolates the HA from the biliary anastomosis and therefore may reduce the risk of severe postoperative HA complications after LT.

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The authors have declared no funding.

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The authors have declared no conflict of interest.

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Authors and Affiliations

  1. Department of General and Liver/Pancreas Transplant Surgery, School of Medicine, Hôpital Saint Eloi, University of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, Cedex 5, France

    Fabrizio Panaro, Hassan Bouyabrine, Jean-Pierre Carabalona, Boris Jung, Georges Philippe Pageaux & Francis Navarro

  2. Department of Radiology, School of Medicine, Hôpital Saint Eloi, University of Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Stephanie Nougaret

  3. Department of Surgery, Liver Transplant Unit, College of Medicine, Montpellier University Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Fabrizio Panaro

Authors
  1. Fabrizio Panaro
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  2. Hassan Bouyabrine
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  3. Jean-Pierre Carabalona
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  4. Stephanie Nougaret
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  5. Boris Jung
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  6. Georges Philippe Pageaux
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  7. Francis Navarro
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Correspondence to Fabrizio Panaro.

Additional information

Fabrizio Panaro and Hassan Bouyabrine contributed equally to this work.

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Panaro, F., Bouyabrine, H., Carabalona, JP. et al. Omental Flap for Hepatic Artery Coverage During Liver Transplantation. J Gastrointest Surg 18, 1518–1522 (2014). https://doi.org/10.1007/s11605-014-2484-6

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  • DOI: https://doi.org/10.1007/s11605-014-2484-6

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