Orthotopic liver transplantation is now considered the definitive treatment for a variety of conditions, including end stage cirrhosis, malignant and benign liver tumours, metabolic disorders and other pathological conditions. ⁽¹⁾

In March 1st 1963, Starzl et al. performed the first liver transplantation in the world. The patient was a 3-year-old boy with biliary atresia who underwent to liver transplantation, however, he died during the surgery because of coagulation disorder and uncontrolled bleeding. No patient have survived more than 23 days in the first 5 liver transplantation performed.⁽²⁾ Over the past 4 decades, the surgical techniques of liver transplantation have evolved and been modified to become technically less challenging and more routinely feasible.⁽³⁾ Currently, liver transplant patients’ survival within the first year is roughly 80% to 90%. ⁽²⁾

Carlos Andrade Marín Hospital is a national reference health centre in Ecuador. From April to October 2016, In the hospital there have been 15 liver orthotopic transplants, it represents 60% of orthotopic liver transplants performed in Ecuador.⁽⁴⁾

Technique surgery

Knowledge of the variety of surgical techniques performed in whole liver transplantation allows a thorough US study to be performed.⁽⁵⁾ Four standard anastomoses are performed during liver transplantation: hepatic artery, portal vein, inferior vena cava (IVC) and bile duct. ⁽¹⁾ Fig 1.

Hepatic artery: There are multiple strategies that can be used for the construction of the hepatic arterial anastomosis. Most commonly, the recipient common hepatic artery (CHA) is used for arterial in-flow. ⁽⁶⁾ Fig 2.

Portal Vein Anastomosis:  The recipient and donor portal veins are cut to appropriate length, and an end-to-end anastomosis is performed.⁽⁶⁾ Fig 1.

Inferior vena cava anastomosis: The piggy-back technique is currently the most widely used technique in the world for caval anastomosis in liver transplantation. ^(3,6) Fig 3. 

Biliary anastomosis: It is usually end to end anastomosis. ⁽⁶⁾ Fig 1.