Objective To analyze the surgical techniques for the procurement and back-table surgery of the graft in living-related small bowel transplantation.
Methods Eligible donor was chosen according to the donor selection criteria of living-related small bowel transplantation, and preoperative plan was designed. A segment of ileum of 120 cm was procured 20 cm proximal to the ileocecal valve which was preserved in the donor. The techniques for the procurement and back-table surgery of the graft were summarized, which included measurement of entire small bowel length from Treitz to ileocecal valve, palpation and transillumination to identify the distal branch of the superior mesenteric artery， and transient blockage of isolated blood vessels with vascular clamps in order to observe the influence on the blood circulation of graft and residual ileum. The detailed manipulation techniques in processing the graft blood vessels were discussed.
Results The operations were successful both on the donor and the recipient. The functions of implanted segment of bowel were well. The donor had no other complications, such as mesenteric thrombi and anastomosis leakage of intestine, except for transient moderate diarrhea. She was discharged 14 days after operation. In the next 8 months of following-up, the donor has not experienced significant alteration in bowel habits or weight loss. Now she is in good appetite, without any changes in the habit and amount on diet. No changes have been found in lifestyle, work habits, or psychosocial conditions after the small bowel donation.
Conclusion The procurement of a segment of ileum as graft and preservation of 20 cm proximal to the donor ileocecal valve may be ideal protocol. Using a standardized technique with attention presents little recent or long-term risks for the donor and brings satisfied effect for the recipient.
Citation：
ZHU Xiaofeng,HE Xiaoshun,QIAN Shikun,HU Hongxing,WANG Dongping,MA Yi,JU Weiqiang,WU Linwei,JI Yong,HUANG Jiefu. Techniques for Procurement and Back-Table Surgery of Graft in Living-Related Small Bowel Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(2): 196-199. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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- 2. Fishbein TM. The current state of intestinal transplantation [J]. Transplantation, 2004; 78(2)∶175.
- 3. Kato T, Ruiz P, Thompson JF, et al.Intestinal and multivisceral transplantation [J]. World J Surg, 2002; 26(2)∶226.
- 4. The Intestinal Transplant Registry (ITR). Available at: http://www.intestinaltransplant. org/ [EB/OL]. Accessed May 7, 2003.
- 5. Gruessner RW, Sharp HL. Living-related intestinal transplantation: first report of a standardized surgical technique [J]. Transplantation, 1997; 64(11)∶1605.
- 6. Pollard SG. Intestinal transplantation: living related [J]. Br Med Bull, 1997; 53(4)∶868.
- 7. Jaffe B. Current indications for and prospects of living related intestinal transplantation [J]. Curr Opinion Organ Transplant, 2000; 5(2)∶290.
- 8. Ghobrial RM, Farmer DG, Amersi F, et al. Advances in pediatric liver and intestinal transplantation [J]. Am J Surg， 2000; 180(5)∶328.
- 9. Panaro F, Testa G, Balakrishnan N, et al. Living related small bowel transplantation in children: 3-dimensional computed tomography donor evaluation [J]. Pediatr Transplant， 2004; 8(1)∶65.
- 10. Taguchi T, Suita S. Segmental small-intestinal transplantation: a comparison of jejunal and ileal grafts [J]. Surgery， 2002; 131(1 Suppl)∶S294.
- 11. Fujimoto Y, Uemoto S, Inomata Y, et al. Small bowel transplantation using grafts from living-related donors. Two case reports [J]. Transpl Int， 2000; 13 Suppl 1∶S179.
- 12. Testa G, Panaro F, Schena S, et al. Living related small bowel transplantation: donor surgical technique [J]. Ann Surg， 2004; 240(5)∶779.
- 13. Ellison MD, McBride MA, Taranto SE, et al. Living kidney donors in need of kidney transplants: a report from the organ procurement and transplantation network [J]. Transplantation， 2002; 74(9)∶1349.
- 14. Beavers KL, Cassara JE, Shrestha R. Practice patterns for long-term follow-up of adult-to-adult right lobectomy donors at US transplantation centers [J]. Liver Transpl， 2003; 9(6)∶645.
