Arterial anastomosis without rotation in adult living donor liver transplantation: a modification to the back-wall-first technique

Objective In this article, we report our experience with a modification of the back-wall-first technique for hepatic arterial anastomosis in living donor liver transplantation. Patients and methods Fifty-one adult living donor liver transplantations (49 modified right lobes and two left lobes) were performed in El-Rajhi Liver Hospital, Assiut University, Egypt, in the period from November 2014 till September 2019. All patients were included. All donors were related to the recipients. Arterial anastomoses were performed under ×6 loupes magnification. Without placing stay sutures, stitching was started in the back-wall by interrupted stitches that were tied immediately without hanging, followed by front-wall stitches in a similar manner. No rotation was applied to the arteries and no bulldog clamps were placed on the donor arteries on most occasions. Results The mean donor age was 25.6±5.9 years; 22 (43.1%) were males. The mean BMI was 25.3±1.9. The mean recipient age was 50.4±11.1 years; there were 37 males (72.5%). The mean BMI was 26.9±4.7. The mean donor artery length and diameter were 14±2.1 and 2.2±0.11 mm, respectively. The donor artery used was the right hepatic artery in 49 patients (96.1%) and the left hepatic artery in two patients (3.9%). Among the recipients the right hepatic artery was used in 36 patients (70.6%), the left hepatic artery in 11 patients (21.5%), the splenic artery in three patients (5.9%), and the common hepatic artery in one patient (2%). Hepatic artery thrombosis occurred once (2%). The median follow-up was 33 months (range, 9-69 months). Conclusions Hepatic arterial anastomosis without rotation of the artery has low risk of hepatic artery thrombosis.