Introduction. Vena cava preservation (VCP) has been associated with an increase in the incidence of hepatic vein obstruction (HVO), a complication that has been treated with different types of anastomosis. The objective of this study was to prospectively compare two techniques for anastomosis.
Patients and method. We studied 171 cases of liver transplantation involving VCP. In the first 87 procedures, suprahepatic anastomosis was performed with two hepatic veins (middle and left), while all three were employed in the remaining 84 cases. We compared the incidence and severity of intraoperative and postoperative HVO in the two groups.
Results. HVO was more significantly more frequent (p < 0.05) and severe when two veins were employed (n = 7, 8%) than when three were involved (n = 1, 1.2%). Five of the patients in whom two hepatic veins were used presented intraoperative venous stasis and two developed postoperative HVO (one with acute and the other with chronic Budd-Chiari syndrome). One of the patients in whom the three veins were employed presented intraoperative venous stasis. There were no problems with postoperative venous drainage.
Conclusion. VCP can be performed systematically using the three hepatic veins without venovenous bypass and with fewer complications related to HVO.