Name of the Procedure:

Backbench Reconstruction of Cadaver or Living Donor Liver Graft Prior to Allotransplantation; Venous Anastomosis, Each

Summary

Backbench reconstruction of a liver graft involves preparing a donated liver (from a deceased or living donor) for transplantation. This preparation includes stitching the veins (venous anastomosis) to ensure proper blood flow once the liver is transplanted into the recipient.

Purpose

The procedure addresses liver failure or severe liver disease in patients needing a liver transplant. The goal is to ensure the donor liver is properly prepared for successful transplantation, leading to improved liver function in the recipient.

Indications

• End-stage liver disease
• Acute liver failure
• Liver cancer that cannot be resected
• Genetic liver diseases Patients are typically selected based on severity of liver disease, overall health, and suitability for transplant surgery.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Adjustment of medications may be necessary.
• Diagnostic tests like blood work, imaging studies, and liver function tests are conducted to assess the patient’s condition.

Procedure Description

1. Donor Liver Extraction: The donor liver, from a cadaver or living donor, is harvested.
2. Backbench Preparation: Surgeons work on a sterile table (backbench) to prepare the graft.
3. Venous Anastomosis: Surgeons meticulously stitch the veins to create proper connections (anastomosis) to ensure adequate blood flow in the transplanted liver.
4. Quality Check: The prepared graft is checked for proper vessel alignment and integrity before transplantation.
   • Tools and equipment include surgical sutures, microscopes for fine work, and specialized surgical instruments.
   • General anesthesia is used during the procedure.

Duration

The procedure typically takes several hours, depending on the complexity of the venous connections needed.

Setting

Performed in a hospital surgical suite, often in specialized transplant centers.

Personnel

• Surgeons specialized in transplant surgery
• Surgical nurses
• Anesthesiologists
• Surgical assistants

Risks and Complications

• Bleeding
• Infection
• Blood clot formation
• Graft failure Complications are managed through careful monitoring and medical interventions as needed.

Benefits

• Improved liver function in patients with severe liver disease
• Potentially life-saving in cases of liver failure Benefits typically become apparent soon after successful transplantation.

Recovery

• Patients are closely monitored in an ICU post-transplant.
• Instructions include medication adherence to prevent rejection, wound care, and regular follow-up visits.
• Recovery time varies, but most patients stay in the hospital for a few weeks, with several months of outpatient recovery.

Alternatives

• Medical management of liver disease
• Other surgical interventions like partial liver resection
• Pros and cons: Alternatives often do not provide a long-term solution like liver transplantation does.

Patient Experience

• Patients won't feel pain during the procedure due to anesthesia.
• Post-procedure, patients may experience discomfort, which is managed with pain relief medications and supportive care for a smooth recovery.