Orthotopic, but Reversed Implantation of the Liver Allograft in Situs Inversus Totalis - A Simple New Approach to a Difficult Problem: Case Report

S. C. Rayhill, D. Scott, S. Orloff, J. L. Horn, J. Schwartz, A. Zaman, A. Sasaki, W. S. Naugler, M. Chang, J. Gaumond, Y. Wu, J. Ham

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Situs inversus totalis is a rare congenital anomaly in which the heart and abdominal organs are oriented in a mirror image of normal. It provides a unique challenge as there is no established technique for liver transplantation in these patients. Employing two major alterations from our standard technique, a liver was transplanted in the left subphrenic space of a patient with situs inversus totalis. First, the liver was flipped 180° from right to left (facing backward). Second, a reversed cavaplasty (anterior, not posterior, donor suprahepatic caval incision) was performed. Otherwise, it was standard, with end-to-end anastomoses of the portal vein, hepatic artery and bile duct. Three years after the entirely uneventful transplant, the recipient continues to enjoy the benefits of a normally functioning liver. The described technique prevented torsion, kinking and tension on the anastomosed structures by allowing the liver to sit naturally in an anatomical position in the left hepatic fossa. As it required no special measurements or maneuvers, the technique was easy to execute and required no donor liver size restrictions. This novel technique, with a reversed cavaplasty and a 180° right-to-left flip of the liver into a left-sided hepatic fossa, may be ideal for situs inversus totalis.

Original languageEnglish (US)
Pages (from-to)1602-1606
Number of pages5
JournalAmerican Journal of Transplantation
Volume9
Issue number7
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

Keywords

  • Cavaplasty
  • Liver transplantation
  • Situs inversus

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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    Rayhill, S. C., Scott, D., Orloff, S., Horn, J. L., Schwartz, J., Zaman, A., Sasaki, A., Naugler, W. S., Chang, M., Gaumond, J., Wu, Y., & Ham, J. (2009). Orthotopic, but Reversed Implantation of the Liver Allograft in Situs Inversus Totalis - A Simple New Approach to a Difficult Problem: Case Report. American Journal of Transplantation, 9(7), 1602-1606. https://doi.org/10.1111/j.1600-6143.2009.02676.x