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01-05-2018 | Original Scientific Report

Is Routine Intraoperative Contrast-Enhanced Ultrasonography Useful During Whole Liver Transplantation?

Authors: Nicolas Golse, Simone Santoni, Vincent Karam, Oriana Ciacio, Gabriella Pittau, Marc-Antoine Allard, Daniel Cherqui, Antonio Sa Cunha, René Adam, Denis Castaing, Eric Vibert

Published in: World Journal of Surgery | Issue 5/2018

Abstract

Background

Vascular complications following liver transplantation (LT) may result from technical deficiencies. Intraoperative diagnosis remains challenging but can prevent serious delayed complications. Intraoperative Doppler ultrasonography (IOUS) represents the gold standard for imaging, although it requires radiological skills. Contrast-enhanced ultrasonography has been reported during postoperative assessments, but never intraoperatively (CE-IOUS). The aim of this study was to assess the feasibility of routine CE-IOUS, to evaluate its impact on surgical strategy and its usefulness.

Methods

All 553 whole LTs performed in our tertiary centre between 01/2010 and 12/2014 were reviewed. We compared perioperative outcomes and long-term survival in IOUS (n = 370) versus CE-IOUS (n = 103) groups. Secondarily, the seven cases where the two imaging findings conflicted (CE+ Group) were matched 1:2 and compared with an exclusively IOUS procedure (CE− Group, n = 14) to assess the consequences of a specific CE-guided strategy.

Results

CE-IOUS assessments were successful in 100% of cases, without any adverse effects. Vascular complications and patient/graft survival rates were identical in the IOUS and CE-IOUS groups (p = 0.65, 0.95 and 0.86, respectively). CE-IOUS confirmed IOUS findings in 93% of cases (n = 96) and led to the realization of an additional procedure (median arcuate ligament lysis) and six conservative strategies despite poor arterial (n = 5) or venous flow (n = 1) under Doppler analysis. The CE+ and CE− groups presented statistically identical perioperative and long-term outcomes.

Conclusion

This study demonstrated the feasibility of CE-IOUS during whole LT. However, we failed to demonstrate any advantages of CE-IOUS over IOUS. Therefore, IOUS currently remains the gold-standard imaging technique for the intraoperative assessment of vascular patency.

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Title: Is Routine Intraoperative Contrast-Enhanced Ultrasonography Useful During Whole Liver Transplantation?
Authors: Nicolas Golse
Simone Santoni
Vincent Karam
Oriana Ciacio
Gabriella Pittau
Marc-Antoine Allard
Daniel Cherqui
Antonio Sa Cunha
René Adam
Denis Castaing
Eric Vibert
Publication date: 01-05-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 5/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4295-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Is Routine Intraoperative Contrast-Enhanced Ultrasonography Useful During Whole Liver Transplantation?

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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