Liver Transplantation In Bangalore

Introduction

• First successful elective liver resection – 1888 (Langenbuch C)
• True anatomical right hepatectomy for cancer – 1952

          (Lortat-Jacob)

• Subsequent experience

      –Not encouraging till 20 years back

      –Morbidity (30%) & mortality (5%)

      –Most common complications : bleeding and bile leak

• Improvements in technique and technology, understanding, ICU care, IR
• <30 % resectable at diagnosis; majority with cirrhosis at presentation/ distant mets/ locally advanced

• Main strategies

      –Inflow and outflow control: non selective/ selective/ total vascular exclusion

      –Safe parenchymal transection: Kelly clysis/ CUSA/ waterjet

      –LN dissection

      –Anaesthesia: hypotensive parenchymal transection, air embolism, bleeding

Indications

• Benign

–Hydatid cysts, adenoma, large symptomatic haemangioma, abscess

–Biliary strictures +/_ atrophy/ cholangitis

• Malignant

–HCC/ IHCC

–Malignant hilar block: cholangio/ Ca GB

–Metastases

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Diagnosis

• CT (triphasic) and MR

     –Size and location according to anatomy

     –Vascular invasion

     –Nodal and distant mets, satellite nodules

     –“Arterial enhancement and venous washout”

      –IHBRD with normal EHBD and no stones with painless jaundice