Miss Guan is in her 50s. Because of hereditary liver disease and a large amount of ascites, her belly is big like a drum and she has no appetite. She is extremely thin, her cheeks are sunken, and her abdominal wall muscles are as thin as paper. If the liver cannot be replaced, it is likely to be life-threatening due to related complications. Fortunately, Miss Xu, the concubine she brought up since she was a child, came forward and donated her right liver through laparoscopy, allowing her aunt to successfully change the liver. Under the full care of the multi-specialty team of Yadong Hospital, both operations went very smoothly.Miss Guan can finally
to return to normal life.
Great love donations are hard to come by, living donors and transplants from relatives are the only hope
Due to the general shortage of transplant organs in China, living donor liver transplantation has become the only hope for patients with end-stage liver failure, accounting for about 90% of domestic liver transplants.
Since the late 1980s, pediatric living donor liver transplantation has been developed. In 1994, when the first adult living donor liver transplantation was carried out, laparotomy was required for liver donation. main source of disease. As a result, major transplant centers around the world strive to reduce wounds. In 2000, French physicians first published laparoscopic pediatric liver donation, because the required liver is relatively small, the anatomy is relatively simple, and the operation is relatively feasible. As for the right liver donation surgery between adults, the procedure is complicated, the anatomy is complex, and the surgical precision is required to be high. Minimally invasive right liver donation surgery has long been considered too difficult to perform.
The Yadong Hospital team is deeply engaged in minimally invasive hepatobiliary and pancreatic surgery, and laparoscopic liver donation has become routine
Yadong Hospital has been developing minimally invasive liver surgery since 2002 and has always been the most active team in China. After accumulating considerable experience in minimally invasive liver resection, biliary tract surgery and pancreas resection, on March 30, 2012, he successfully completed the first laparoscopic right liver donation operation in the country, becoming the first laparoscopic right liver donation in the country after Seoul University in South Korea. The second successful center in the world. The surgical wound was only 7.5 cm. Subsequently, 34 laparoscopic liver donation operations were completed successively, and the success rate of the donor’s operation reached 100%. None of the donors experienced serious postoperative complications. Avoid more than 10% chance of complications after traditional liver donation surgery, including wound infection, hernia, intra-abdominal bleeding, bile duct obstruction, bile leakage, intra-abdominal infection, pleural effusion or ascites, etc. It has always been the main stress burden for liver transplant families.
Living donor liver transplantation has a high success rate, but both the donor and recipient must meet the conditions
Common liver transplantation indications
End-stage cirrhosis (including: chronic hepatitis B, C and cholestatic cirrhosis)
Liver cancer within the condition
Congenital biliary atresia
Inborn errors of metabolism
Inferior vena cava occlusion Bud-Chiari syndrome, etc.
At present, the most common cause of liver transplantation in China is liver cirrhosis and liver cancer. The so-called liver cancer within the conditions, in living donor liver transplantation, refers to the following conditions: a single tumor less than 6.5 cm. For multiple tumors, the total number is less than 3, the largest diameter is less than 4.5 cm, and the total diameter is less than 8 cm. However, it must not have extrahepatic metastasis and major vascular invasion in the liver.
Conditions that must be considered when considering a living liver donor
Physical and mental health, over 20 years old or over 18 years old with the consent of the legal representative
Normal liver function, no moderate or above fatty liver
Blood type compatible
Appropriate liver size
No complex anatomical variation in blood vessels and biliary tract
The anatomy of blood vessels and biliary tract is the most important factor in determining the success or failure of liver donation surgery. The main hepatic vein branches (diameter greater than 0.5 cm) must be reconstructed. The severing of the bile duct must be precise, in order to take into account the safety of the donor and the recipient, and to avoid complications. Our team has accumulated the most experience in minimally invasive biliary tract surgery in China and developed a series of programs to ensure the safety of donors. Including: intraoperative cholangiography, ICG fluorescence cholangiography, using rich surgical experience and new laparoscopic stereoscopic imaging system to handle all possible biliary tract separation and reconstruction. All minimally invasive liver donors had no biliary complications.
The so-called appropriate size means that the donated liver must be more than 0.8% of the recipient’s body weight. For example, if the body weight is 70 kg, the transplanted liver needs to be more than 560 grams. Moreover, the liver volume retained by the liver donor must exceed 35% of the original volume to avoid postoperative liver failure. Donors receive standard post-operative care for laparoscopic liver resection and can eat for 6 hours post-operatively without waiting for a gas. There is no nasogastric tube after the operation, and you can get out of bed freely after the operation. Surgical wounds are usually sutured under the skin, and there is no need to change dressings at home, you can shower, and there is no need to remove the sutures when you come to the clinic. Usually the postoperative hospital stay is between 5 and 7 days. A balanced diet is recommended to help the liver regenerate. Due to the large number of liver resections, outpatient follow-up must be performed on a regular basis, including: abdominal ultrasound or computed tomography scans, blood tests to confirm the recovery of liver function between three months and six months. Liver regeneration is expected to be completed within two months after surgery, restoring approximately 80% to 90% of the original liver volume.
Epilogue
The team of our hospital has accumulated many years of experience in minimally invasive hepatobiliary and pancreatic surgery, and has developed corresponding minimally invasive techniques for most anatomical variations of blood vessels and biliary tract. Laparoscopic liver donation surgery is already a safe and effective option. It can help people who are interested in donating livers to reduce the pain and risk of surgery, and further reduce their doubts about donating livers. However, living donor liver transplantation is still a complicated and difficult operation. It requires a high degree of multi-specialty teamwork to be successful. Before the operation, the medical team fully communicates and decides the most suitable plan.