Isolated bowel transplant
With aortic and caval vascular conduits
00:07 SURGICAL PLANNING
02:07 Recipient Operation: Exposure of infra-renal vessels
04:36 RECIPIENT OPERATION: Vascular reconstruction - SMV & SMA jump graft
06:07 RECIPIENT OPERATION: Vascular reconstruction - Donor SMA & SMV anastomoses to vascular conduits
Case description
- Although bowel transplantation has been an accepted surgical procedure for several decades, there is no standard approach to establishing the arterial inflow and venous outflow. In this video we present a case of an isolated bowel transplant in which the arterial inflow and venous outflow were established using donor arterial and venous interposition grafts.
- A 22-year-old woman had a traumatic avulsion of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). She was left with 30cm of jejunum, transverse colon, descending colon, and rectum.
- The donor intestine is separated from the pancreas so that both can be used in separate recipients. This is achieved by carefully preserving the inferior pancreaticoduodenal artery on the pancreas side and middle colic artery on the intestinal side.
- In the recipient operation, vascular grafts are attached to the inferior vena cava and infrarenal aorta. With vascular grafts in place, the bowel graft is easy to orient and vascular anatomosis of SMA and SMV are straightforward and fast.
CT scans (recipient pre-op)
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CT scans (recipient post-op)
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