Surgical treatment for common hepatic aneurysm. Original one-step technique

IntroductionHepatic artery aneurysms are rare, and their treatment represents a challenge for the surgeons.Materials and methodsA new technique is presented for common hepatic artery (CHA) aneurysm: it requires minimal vascular surgical dissection and only one linear vascular stapler is applied at the bottom of aneurysm. Aneurysm exclusion is easily obtained, which allowed retrograde thrombosis. Liver blood supply is ensured to the right and left hepatic artery, through the gastroduodenal artery, and can be previously monitored, with temporary clamping of the section area, by visual control, enzyme evaluation and intraoperative ultrasound examination. We reported an open surgical treatment, with simultaneous removal of hepatic and adrenal metastases, secondary to colon cancer.ResultsThe duration of vascular surgery was 30 min and did not involve complications. Postoperative controls confirmed the efficacy of the procedure.DiscussionThis original technique can be added to the various open and endovascular techniques so far described for the treatment of a CHA aneurysm. It is advisable as open surgery, mostly in case of associated pathologies.ConclusionsThe authors believe that this “one shot” technique by vascular staple of the distal part of CHA is minimally invasive and effective to obtain the exclusion of the aneurysm.

Transplantation of a horseshoe kidney from a living donor using stapler for transsection

Although it rather became a routine procedure to evaluate and use a cadaveric horseshoe kidney, using one from a living donor is quite rare. In this paper, we present methods we used during such a case which may benefit the procedures in the future. A 29-year-old female patient was considered for transplant and only viable living donor was her 59-year-old mother. Dynamic computed tomography revealed horseshoe anomaly with one renal artery and one renal vein for each side, a long but thin isthmus connecting lower poles with no visible arterial supply. Descending urography showed no connecting caliceal system. Donor nephrectomy was performed and isthmus separation was carried out with vascular stapler. Recipient was discharged on the 6th day with no complications. Patient was followed up for 6 months with normal creatinine levels. When properly assessed before the surgery, using a horseshoe kidney is not so challenging as thought.