Introduction : The hepatic artery (HA) reconstruction in living donor liver transplantation (LDLT) is a crucial step because of the smaller diameter of the artery and the increased risk of HA related complications. Also, any occurrence of the HA flow abnormalities in the immediate postoperative period may lead to fetal complications. Therefore, many centers use a micro-surgical technique for HA reconstruction. The aim of our study was to investigate the outcomes that HA reconstruction was performed under surgical loupe.

Methods : This study included 44 LDLTs with various end stage liver diseases at Dong-A university hospital Busan, Korea from January, 2014 to August, 2018. The medical records were retrospectively analyzed for the outcomes and HA related complications.

Results : HA reconstruction for the initial 13 LDLT surgeries was performed using a micro-surgical technique. From 14 LDLT case, HA reconstruction was performed in 31 recipients under surgical loupe with interrupted suture on posterior HA wall and running suture on anterior wall.
We performed HA reconstruction in 30 adults, 1 pediatric patient (one year old) under surgical loupe, which included one dual graft LDLT.
The most notable factor in surgical loupe group compared with micro-surgical group (33? minutes) was the quick HA anastomosis procedure with a mean time of 12? minutes.
Fortunately, there were no HA related complications in both groups.

Conclusions : Although our case is not enough, we could consider that the HA reconstruction using surgical loupe even in smaller diameter hepatic arteries is a reliable technique and can easily be applied by an experienced surgeon