Digestive tract reconstruction and postoperative management of upper abdominal multivisceral transplantation

OBJECTIVE: To explore the method of digestive tract reconstruction and postoperative management in the upper abdominal multivisceral transplantation (MVT). METHODS: The data of a pancreatic cancer patient with multiple liver metastases, undergone the first upper abdominal MVT in Asia on May 2004, was investigated retrospectively. RESULTS: During the operation, liver, gall bladder, pancreas, duodenum, part of jejunum, total stomach, greater and lesser omentum, and spleen were all resected from the recipient. Roux-en-Y procedure was adopted for the reconstruction of digestive tract, including closing the proximal end of donor duodenum, anastomosing recipient jejunum with horizontal part of donor duodenum, transecting the jejunum 35 cm from the anastomosis, end-to-side anastomosing the distal cut end of jejunum with the end of esophagus, and end-to-side anastomosing proximal cut jejunum with jejunum 50 cm away from esophageal anastomosis. Drainage tube was left inside duodenum and jejunum stoma was made for nutrient canal.The endocrine of pancreas was suppressed by the use of somatostatin postoperatively. Removing of nasogastric tube and duodenum draining tube were delayed. Bowel function recovered 4 days postoperatively and gradually resumed ordinary diet. One month after operation, the patient had no other complications except diarrhea. CONCLUSION: The success of upper abdominal MVT supplies precious experience in digestive tract construction and postoperative management.