Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.41
Peer-review started: September 29, 2014
First decision: January 8, 2015
Revised: January 28, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: March 28, 2015
There are several caval reconstruction techniques currently in use for orthotopic liver transplantation. These include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There are few randomized controlled trials comparing the use of these techniques and our knowledge of their comparability is based on a few multi- and many single-center retrospective and prospective reviews. Although there are advantages and disadvantages for each technique, it is advisable that the surgeon perform the technique with which they have the most the experience and at which they are the most skilled as excellent outcomes can be obtained with any of the caval reconstruction options discussed.
Core tip: There are multiple options available for caval reconstruction currently in use for orthotopic liver transplantation. Those options include caval replacement or the conventional technique, performed with or without venovenous bypass, piggyback technique with anastomosis with two or three hepatic veins with or without cavotomy and modifications of the piggyback technique including end-to-side and side-to-side cavocaval anastomosis. There is currently no consensus in regards to the best technique although there are advantages and disadvantages for each. Excellent outcomes can be obtained with any of the described techniques and the surgeon’s comfort and skill with the technique is likely the most important factor.