Right hemihepatectomy for living donor liver transplantation in adults (open technique)

In this Chapter we discuss the technical details of the right hemihepatectomy for living donor liver transplantation in adults by open technique. Successful donor outcome and the recipient’s hope for the highest probability of a successful transplant are relevant factors that ethically support the choice for living donor liver tranplantation. The liver’s extrahepatic vasculobiliary anatomy should be carefully determined by recognizing preoperatively all different types of the anatomical pattern. Graft weight/recipient weight ratio >0.8 % and a graft volume/standard liver volume ratio >40 % are the safe limits to avoid small for size syndrome in recipients. During right hemiepatectomy leave untouched the left triangular ligament or the gastrohepatic ligament, because their section produces an excessive mobility of the left lobe with possible torsion or kinking and outflow occlusion of the remnant graft. Throughout the hilar dissection, extreme care should be employed to avoid the devascularization of the common bile duct with possible ischemic biliary stricture in the donor. The preservation of the mean hepatic vein avoids the congestion of S IV and subsequent liver dysfunction in the donor. Try to perform extensive revascularization of all hepatic vein tributaries of the MHV (V5, V8) and all accessory hepatic veins (V6 and V7), when with caliber >4 mm. To maintain the correct parenchyma transection plane, the “hanging maneuver” may be useful.