Piggyback Techniques

In certain cases, removal of the cava is not necessary. In these cases, leaving the recipient's cava in place and dissecting the caudate lobe off the cava by dividing the short hepatic veins individually preserves the caval continuity. This leaves the liver attached by the three main hepatic veins. These are controlled with a clamp, and a common cuff fashioned from the orifices of the three veins, which

Figure 10.7. The final result.

in turn is anastomosed to the donor liver's suprahepatic cava. Bypass, either total or partial (only portal flow diverted), may be instituted or omitted altogether. If bypass is omitted, this is accomplished either by creating a temporary portocaval shunt or by simply clamping the portal vein, if the hemodynamic status of the patient allows it. There is no need to perform a lower caval anastomosis, and the donor infrahepatic cava is tied or stapled shut. The rest of the case proceeds as described earlier.

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