Review
Copyright ©The Author(s) 2015.
World J Surg Proced. Mar 28, 2015; 5(1): 41-57
Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.41
Table 2 The piggyback technique
Ref.nAnastomosisVVBTPCSComplications reportedConclusion
Fleitas et al[26] single center44 OLTs 39 patientsLMNoNoHepatic artery thrombosis (1), suprahepatic stricture (1), retransplant (5 - hepatic artery thrombosis, suprahepatic stricture, primary nonfunction, rejection), relaparotomy for bleeding (2), splenic steal (1)Piggyback operation could be done in most OLTs, not restricted to certain anatomic situations. Lateral IVC clamping and unclamping results in good hemodynamic stability. Vascular complications, blood requirements, retransplantation, overall survival similar to that reported with standard technique
Belghiti et al[8] single center51LMNoYes, 100%Four postoperative deaths (sepsis and primary nonfunction - 2, nosocomial pneumonitis at 3 and 5 mo - 2), no pulmonary embolism, NO IVC stump thrombosisPiggyback technique was always technically feasible irrespective of graft size, VVB not required
Levi et al[27] single centerEra I: 945 of 1080 (87.5%)LMR when possible177 (18.7%)NoOutflow obstruction (6)Increasingly used piggyback technique over time (P < 0.0002). Over time had shorter warm ischemia time (P = 0.0004), less frequent need for VVB (P = 0.001). Hepatic venous outflow obstruction rarely encountered
Era II: 851 of 920 (92.5%)LMR when possible97 (11.4%)NoOutflow obstruction (3)
Ducerf et al[5]88 OLTs, 81 patientsLM vs LM+ 3-cm cavotomyNoNoNo outflow obstruction (0)Preservation of the IVC with recipient caval anastomosis with MHV and LHV is reliable. Associated cavotomy is not necessary
Parrilla et al[13] multi-center1112440 LM 672 LMRNo6 at one centerAbdominal bleeding (2), acute outflow obstruction (9), ascites (3), intraoperative complications (28 - 2 venous tears, 26 congestion), graft failure (11)Complications inherent to the piggyback technique including intraoperative venous congestion and acute and chronic Budd Chiari syndrome were more common when patients underwent anastomosis with two suprahepatic veins vs three (P < 0.001)
Cescon et al[4]431LM, LMR, LM+ 1 cm cavotomyNoNoComplications related to anastomosis (20, 4.6%)Increase in complications related to caval anastomosis in patients with two-vein anastomosis (LM vs LM+ P < 0.0001, LM vs LMR P = 0.065, LM+ vs LMR P = 0.4). Orifice formed with two veins is not sufficient. Advocate balloon angiography for dilation of anastomotic narrowing in most cases
Robles et al[17]17187 LM 84 LMRNoNoHepatic venous outflow obstruction in 7 patients with LM (8%) and in 1 patient with LMR (1.2%)Increase in hepatic venous outflow obstruction in patients with two-vein anastomosis (P < 0.05)