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going to be used then the proximal superior mesenteric artery will need to be preserved for the head of the pancreas and the artery will have to be divided immediately below the uncinate process. In all of these circumstances, extra segments of donor artery, preferably the iliac artery; and donor vein, preferably the iliac vein, should be taken in case vascular extension grafts are needed when the small bowel allograft is revascularized.

In general, after the abdomen is open, the first step in small bowel procurement is to perform a gross visual inspection of the small bowel. If all appears well, the omentum should be taken off the right side of the transverse colon to approximately the mid transverse colon. Care must be taken not to transect the transverse mesocolon. At this point, after identifying the middle colic vessels, a site immediately to the donor's left of the middle colic vessels is chosen as the distal extent of the small bowel graft. A small hole is made in the transverse mesocolon at this site in preparation for transsection of the bowel. Next after entering into the lesser sac along the greater curvature of the stomach near the pylorus, the pylorus is encircled taking care not to injure the arteries going to the liver. An NG tube is then manipulated into the duodenum where the Amphotericin/Neomycin/Erythromycin base solution is infused. Once the solution has been infused [250-500cc], and the NG tube is withdrawn into the stomach, the pylorus is divided using a GIA stapler. After a few minutes are given for the solution to pass through the small bowel and into the colon, the jejunum just distal to the ligament of Treitz is encircled and divided using a GIA stapler. Next the transverse colon should be divided at the previously selected site. If any solid stool is palpated in the right colon it should be milked distally prior to transection so that it is not included in the graft. Therefore, the intestinal segment to be removed extends from the ligament of Trietz to the mid-transverse colon. After this segment has been completely mobilized, attention is diverted to the arterial and venous supply, which are isolated as described previously.

For procurement of a liver-intestine graft, the portal vein is not divided but is procured in continuity with the liver after ligating all posterolateral branches in the head of the pancreas. The correct orientation of the portal vein should be made apparent using small clips or indelible ink to avoid twisting during implantation. The hepatic arteries are also not divided but are procured in continuity with the celiac artery, SMA and a long, adjoining segment of thoracic aorta.

For a multivisceral transplant, all organs to be transplanted are removed en bloc with their blood supply procured in continuity with the celiac artery, SMA and a long, adjoining segment of thoracic aorta.3

When the organs are ready for removal a cannula is placed in the distal aorta, which is flushed retrogradely with University of Wisconsin solution. Simultaneous with initiation of the flush, the supra-hepatic vena cava is partially divided in the chest cavity to facilitate extravasation. The thoracic aorta is also clamped in the chest. After the small bowel graft has been extravasated and completely flushed with cold preservation solution, it is removed and placed in sterile bags which are placed in a cooler for transport.

It is very important that the small bowel procurement is done in close coordination with the preparation of the recipient. The two procedures should be timed so that when the donor team arrives back at the recipient hospital, all is ready for the graft revascularization.

Baby Sleeping

Baby Sleeping

Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

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