The role of intraoperative ultrasonography in detection of hepatic vascular variations in living donor liver transplation

With advances in surgical technique and immunosuppression, liver transplantation has become the most effective treatment of acute and chronic liver failures. Evaluation of vascular anatomy and detection of hepatic vascular variations prior to surgery, especially transplantation surgery, can help reduce complications in both the donor and the recipient. Inraoperative ultrasonography (IOUS) is known to be beneficial during planning of the transplantation surgery and can help direct surgery. To our knowledge, there are no studies in the literature that evaluate the number and diameter of segment 5 and 8 branches that need to be anastomosed with IOUS. In this study, considering surgical anatomical evaluation as the gold standard, IOUS findings were compared to computed tomography angiography (CTA) findings. 40 patients were included in the study. Average diameters of segment 8 branches that were anastomosed and not anastomosed were significantly different as measured by IOUS (p=0,016); however no such statistically significant difference was found in measurements made with CTA (p=0,89). CTA is superior to IOUS in detecting segment 5 and 8 veins draining into to middle hepatic vein. However, IOUS is more accurate in predicting which vessels are going to be anastomosed. For a complete and accurate assessment, both imaging modalities should be used to complement each other and advantages and disadvantages of both imaging modalities should be known.