Modified back wall first artery anastomosis technique in living donor liver transplantation

Summary Background/Objectives Back wall technique is usually used for hepatic artery anastomosis in living donor liver-transplantation. In this technique, two stitches are placed in the two corners of the artery wall initially and the microclamp on the artery is rotated to place the sutures to the back wall first. In some cases, the microclamp cannot be rotated because of insufficient length of the graft or recipient artery. If this occurs, it may be difficult to rotate the artery to perform the back wall artery anastomosis technique. In these cases, the difficulty of performing the anastomosis can cause intimal tears. Thus, we prefer a modified technique for artery anastomosis in such situations. Methods In this modified technique, two stitches are placed in the middle of the posterior wall and middle of the anterior wall initially. The artery is twisted 90° to the right side and to the left side respectively, instead of one 180° rotation, to place the back wall stitches. Conclusion In this modified technique, reversing the microclamp is eliminated that can cause intimal damage. Therefore, it may be superior to the conventional method in terms of reducing the difficulty of performing anastomosis and intimal damage to the vessels.