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. 1995 Jul;222(1):47–50. doi: 10.1097/00000658-199507000-00008

Evaluation, operative management, and outcome after liver transplantation in children with biliary atresia and situs inversus.

D G Farmer 1, A Shaked 1, K M Olthoff 1, D K Imagawa 1, J M Millis 1, R W Busuttil 1
PMCID: PMC1234754  PMID: 7618968

Abstract

INTRODUCTION: Biliary atresia, a common indication for liver transplantation, can be associated with situs inversus. Our experience with liver transplantation in children (n = 6) was reviewed retrospectively. PATIENTS AND METHODS: Preoperative duplex sonography, computerized tomography, and visceral angiography were obtained. Vascular anomalies identified included preduodenal portal vein (6/6), interrupted inferior vena cava (5/6), and aberrant hepatic artery (4/6). RESULTS: The liver graft was placed in a midline position. Venous continuity was achieved by donor suprahepatic inferior vena cava to recipient hepatic cloaca and direct end-to-end portal anastomosis. The donor infrahepatic inferior vena cava was oversewn. Arterial continuity was restored using either a direct branch-patch anastomosis (3/6) or a supraceliac aortic interposition graft (3/6). In retrospect, preoperative diagnostic work-up was noncontributory and outcome was not complicated by pre-existing situs inversus. CONCLUSION: Situs inversus in liver recipients requires operative technical modifications, but does not change outcome. Furthermore, extensive preoperative work-up should be avoided.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barone G. W., Henry M. L., Elkhammas E. A., Tesi R. J., Ferguson R. M. Orthotopic liver transplantation with abdominal situs inversus and dextrocardia. Am Surg. 1992 Oct;58(10):651–653. [PubMed] [Google Scholar]
  2. Busuttil R. W., Seu P., Millis J. M., Olthoff K. M., Hiatt J. R., Milewicz A., Nuesse B., el-Khoury G., Raybould D., Nyerges A. Liver transplantation in children. Ann Surg. 1991 Jan;213(1):48–57. doi: 10.1097/00000658-199101000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Falchetti D., de Carvalho F. B., Clapuyt P., de Ville de Goyet J., de Hemptinne B., Claus D., Otte J. B. Liver transplantation in children with biliary atresia and polysplenia syndrome. J Pediatr Surg. 1991 May;26(5):528–531. doi: 10.1016/0022-3468(91)90698-s. [DOI] [PubMed] [Google Scholar]
  4. Fonkalsrud E. W., Tompkins R., Clatworthy H. W., Jr Abdominal manifestations of situs inversus in infants and children. Arch Surg. 1966 May;92(5):791–795. doi: 10.1001/archsurg.1966.01320230139025. [DOI] [PubMed] [Google Scholar]
  5. Hiatt J. R., Ament M. E., Berquist W. J., Brems J. F., Brill J. E., Colonna J. O., 2nd, el Khoury G., Quinones W. J., Ramming K. P., Vargas J. H. Pediatric liver transplantation at UCLA. Transplant Proc. 1987 Aug;19(4):3282–3288. [PubMed] [Google Scholar]
  6. Hoffman M. A., Celli S., Ninkov P., Rolles K., Calne R. Y. Orthotopic transplantation of the liver in children with biliary atresia and polysplenia syndrome: report of two cases. J Pediatr Surg. 1989 Oct;24(10):1020–1022. doi: 10.1016/s0022-3468(89)80206-4. [DOI] [PubMed] [Google Scholar]
  7. Iwatsuki S., Shaw B. W., Jr, Starzl T. E. Liver transplantation for biliary atresia. World J Surg. 1984 Feb;8(1):51–56. doi: 10.1007/BF01658363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Klintmalm G. B., Bell M. S., Husberg B. S., Holman M. J., Goldstein R. M., Ramsay M. A., Polter D. E. Liver transplant in complete situs inversus: a case report. Surgery. 1993 Jul;114(1):102–106. [PubMed] [Google Scholar]
  9. Lerut J., Tzakis A. G., Bron K., Gordon R. D., Iwatsuki S., Esquivel C. O., Makowka L., Todo S., Starzl T. E. Complications of venous reconstruction in human orthotopic liver transplantation. Ann Surg. 1987 Apr;205(4):404–414. doi: 10.1097/00000658-198704000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Lilly J. R., Starzl T. E. Liver transplantation in children with biliary atresia and vascular anomalies. J Pediatr Surg. 1974 Oct;9(5):707–714. doi: 10.1016/0022-3468(74)90109-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Millis J. M., Brems J. J., Hiatt J. R., Klein A. S., Ashizawa T., Ramming K. P., Quinones-Baldrich W. J., Busuttil R. W. Orthotopic liver transplantation for biliary atresia. Evolution of management. Arch Surg. 1988 Oct;123(10):1237–1239. doi: 10.1001/archsurg.1988.01400340063011. [DOI] [PubMed] [Google Scholar]
  12. Raynor S. C., Wood R. P., Spanta A. D., Shaw B. W., Jr Liver transplantation in a patient with abdominal situs inversus. Transplantation. 1988 Mar;45(3):661–663. doi: 10.1097/00007890-198803000-00034. [DOI] [PubMed] [Google Scholar]
  13. Ruben G. D., Templeton J. M., Jr, Ziegler M. M. Situs inversus: the complex inducing neonatal intestinal obstruction. J Pediatr Surg. 1983 Dec;18(6):751–756. doi: 10.1016/s0022-3468(83)80018-9. [DOI] [PubMed] [Google Scholar]
  14. Shaked A. A., Takiff H., Busuttil R. W. The use of the supraceliac aorta for hepatic arterial revascularization in transplantation of the liver. Surg Gynecol Obstet. 1991 Sep;173(3):198–202. [PubMed] [Google Scholar]
  15. Todo S., Hall R., Tzakis A., Starzl T. E. Liver transplantation in patients with situs inversus. Clin Transplant. 1990 Feb;4(1):5–8. [PMC free article] [PubMed] [Google Scholar]
  16. Tzakis A., Todo S., Starzl T. E. Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg. 1989 Nov;210(5):649–652. doi: 10.1097/00000658-198911000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]

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