Right lobe live donor liver transplantation portal venous branching anomalies and malatya approach

Aim: The aim of this study is to remove the difficulties based on portal vein anomalies faced with graft in liver transplant with right lobe living donor and to define a new technique called as Malatya Approach combined two or three portal ven orifice extended at least 1-2 cm, wider than its original one and presented as transforming into just one orifice and to define a new surgical technique and research the efficiency of this technique.The patients and method: Between April 2002 and March 2011 the liver transplant was carried on 558 patients in our centre, 440 of who are living donors ones and 396 of whom (90 %) are right lobe living donor liver transplantations. This study covers only those patients on whom living donor liver transplant has been performed by using right lobe graft. According to Nakamura classification, there was abnormal portal vein branch in 50 (12.6 %) out of 396 patients on whom the right lobe living donor liver transplant has been performed. 346 out of 396 right lobe graft consists of Type A (87.4%), Type B out of 20 (5%), Type C out of 18 (4.6%), Type D out of 12 (3%). Premier approximation in 10 patients with abnormal portal vein branch (type B,C,D) grafts , Y-Plasty in 7 patients, double anastomos in 3 patients, complicated venoplasty in 3 patients, in 27 patients Malatya Approach technique has been implemented.Results: The technique of Malatya Approach implemented on 27 patients has been found out to be efficient and easily applicable. Portal vein trombosis has not been observed in the statistical meaningful rate on patients on whom portal vein anastomosis has been operated through conventional techniques. The rate of relaparatomy and mortality has been seen to be more on patients on whom portal ven anastomoz has been operated through conventional techniques.Comment: We are of the opinion that results of the thesis have confirmed that the use of Malatya Approach technique in the reconstruction of right lobe grafts with double portal vein is easy, an efficient method and can be standard procedure in abnormal vein branch.Key words: Live donor liver transplantation, Abnormal portal venous branch, Malatya Approach