Fig. 42.

Technical steps in human homotransplantation. A, external bypass systems used for decompression of blocked venous pools. External shunt from the portal system was shown to be unnecessary and only vena caval bypass is required. B, operative field after removal of recipient’s diseased liver. C, anastomosis of suprahepatic vena cava. Great care must be exercised to prevent suture-line leakage, because exposure of this suture line is difficult after homograft is in place. D, completed anastomoses of portal structures. Note that T-tube is placed through a stab wound in recipient portion of reconstructed common duct. An alternative method of internal biliary drainage is with cholecystoenterostomy.