Does surgical technique matter? Comparing intraoperative outcomes and hemodynamic stability between classical and piggyback liver transplantation - 01/03/26
, Thien Nguyen Duc a , Thao Ngo Van a , Quang Dang Tuan a , Dinh Ngo Manh a , Nuong Tran Thi a , Nghia Nguyen Quang b , Khai Ninh Viet b , Phuong Tran Ha b , Dang Do Hai b , Tuan Hoang b , Dung Tran Dinh b , Hung Duong Duc c
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Abstracts |
Background |
: Classical and piggyback techniques had their own advantages and disadvantages. With some technique modifications, we would like to assess its impact during the operation.
Objective |
: To compare the impact of surgical techniques on Post-reperfusion Syndrome (PRS) and blood loss, ischemic time between our modified classical and piggyback techniques in deceased donor liver transplantation (DDLT).
Methods |
: A retrospective cross-sectional study was conducted on 40 patients undergoing DDLT at Viet Duc university hospital from January 2024 to June 2025. Patients were categorized into two groups: Modified classical technique without veno-veno bypass ( n = 21) and Piggyback technique ( n = 19). Key outcomes included the incidence of PRS and intraoperative factors such as ischemia times, blood loss and transfusion requirements.
Results |
: Post-reperfusion hemodynamic disturbances were observed in 60% of the total patients. In the classical group, though higher MELD scores (21.43 ± 12.37 vs. 13.58 ± 9.58, p = 0.032), the operation time and anhepatic time were shorter respectively (360.0 ± 59.3 vs 433.2 ± 66.2 mins, and 21.5 ± 2.4 vs. 37.2 ± 9.7 mins, p < 0.001). 55% of patients experienced significant hypotension, 42.5% developed bradycardia, and 12.5% asystole. The modified classical group exhibited a significantly higher rate of hemodynamic disturbances compared to the piggyback group (90.5% vs. 26.3%, p < 0.001). Notably, 100% of Child-Pugh C patients experienced PRS, regardless of techniques. MELD score, anhepatic time, blood loss, Child-Pugh and technique was correlated with hemodynamic disturbance ( p < 0.05).
Conclusion |
: The modified classical technique optimizes surgical efficiency by reducing operative time, anhepatic time, and blood loss compared to the piggyback approach. However, these benefits are offset by a significantly higher incidence of severe hemodynamic instability and post-reperfusion syndrome. Consequently, further technical refinements and enhanced anesthetic strategies are imperative to balance procedural advantages with cardiovascular safety.
Le texte complet de cet article est disponible en PDF.Keywords : DDLT, Hemodynamics, Post-reperfusion syndrome, Classical technique, Piggyback technique
Plan
Vol 22
Article 100334- mai 2026 Retour au numéro
Article précédent
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