%0 Journal Article
%T Reconstru  o arterial no transplante hep¨¢tico: a melhor reconstru  o para varia  o da art¨¦ria hep¨¢tica direita Artery reconstruction in liver transplantation: the best reconstruction of right hepatic artery variation
%A Wellington Andraus
%A Luciana BP Haddad
%A Liliana Ducatti
%A Rodrigo B Martino
%J ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S£¿o Paulo)
%D 2013
%I Col¨¦gio Brasileiro de Cirurgia Digestiva
%X INTRODU  O: Varia  es na anatomia da art¨¦ria hep¨¢tica s o comuns, com incid¨ºncia de 20-50%. No transplante hep¨¢tico, reconstru  es durante a oper  o de bandeja s o frequentemente necess¨¢rias para proporcionar anastomoses arteriais adequadas. O uso de "patch" ¨¦ frequente, visando reduzir a incid¨ºncia de complica  es. Entretanto, quando est¨¢ presente a varia  o da art¨¦ria hep¨¢tica direita, ramo da art¨¦ria mesent¨¦rica superior, a reconstru  o ocasionalmente produz tor  es e problemas de fluxo. M¨¦TODOS: Descreve-se uma t¨¦cnica cir¨²rgica alternativa para reconstru  o da varia  o da art¨¦ria hep¨¢tica direita usando um "patch de Carrel" da art¨¦ria mesent¨¦rica superior. O "patch" ¨¦ anastomosado no coto da art¨¦ria espl¨ºnica permitindo orienta  o vertical e bom fluxo sangu¨ªneo. RESULTADOS: Entre 120 transplantes hep¨¢ticos, quatro casos consecutivos de varia  o da art¨¦ria hep¨¢tica direita foram reconstru¨ªdas utilizando essa t¨¦cnica. Todos eles apresentaram pat¨ºncia e bom fluxo no p¨®s-operat¨®rio. CONCLUS O: A t¨¦cnica proposta mostra-se interessante m¨¦todo alternativo para reconstru  o da varia  o da art¨¦ria hep¨¢tica direita no transplante hep¨¢tico. INTRODUCTION: Variations on the anatomy of the hepatic artery are common, with incidence of 20-50%. In liver transplantation, back-table reconstruction is often necessary for an easier and prompt arterial anastomosis and so, the use of arterial patches has been related to lower the incidence of complications. However, when a right hepatic artery variation from the superior mesenteric artery is present, the reconstruction occasionally produces twisting and flow problems. METHODS: Is described a surgical alternative for right hepatic artery variation reconstruction using a Carrel-patch from the superior mesenteric artery. The patch is anastomosed with the splenic artery stump to allow vertical orientation and improve blood flow. RESULTS: Among 120 liver transplants, four consecutive cases of right hepatic artery variation were reconstructed using this technique. All of them showed good flow and patency in postoperative period. CONCLUSION: The proposed technique proved to be an interesting alternative for the reconstruction of right hepatic artery variation in liver transplantation.
%K Laparoscopia
%K H¨¦rnia Inguinal
%K Tela cir¨²rgica
%K Laparoscopic surgery
%K Inguinal hernia
%K Surgical mesh
%U http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-67202013000100014