Does surgical technique matter? Comparing intraoperative outcomes and hemodynamic stability between classical and piggyback liver transplantation

: Classical and piggyback techniques had their own advantages and disadvantages. With some technique modifications, we would like to assess its impact during the operation. : To compare the impact of surgical techniques on Post-reperfusion Syndrome (PRS) and blood loss, ischemic time between our modified classical and piggyback techniques in deceased donor liver transplantation (DDLT). : A retrospective cross-sectional study was conducted on 40 patients undergoing DDLT at Viet Duc university hospital from January 2024 to June 2025. Patients were categorized into two groups: Modified classical technique without veno-veno bypass (n=21) and Piggyback technique (n=19). Key outcomes included the incidence of PRS and intraoperative factors such as ischemia times, blood loss and transfusion requirements. : Post-reperfusion hemodynamic disturbances were observed in 60% of the total patients. In the classical group, though higher MELD scores (21.43 ± 12.37 vs. 13.58 ± 9.58, p = 0.032), the operation time and anhepatic time were shorter respectively (360.0 ± 59.3 vs 433.2 ± 66.2 mins, and 21.5 ± 2.4 vs. 37.2 ± 9.7 mins, p < 0.001). 55% of patients experienced significant hypotension, 42.5% developed bradycardia, and 12.5% asystole. The modified classical group exhibited a significantly higher rate of hemodynamic disturbances compared to the piggyback group (90.5% vs. 26.3%, p < 0.001). Notably, 100% of Child-Pugh C patients experienced PRS, regardless of techniques. MELD score, anhepatic time, blood loss, Child-Pugh and technique was correlated with hemodynamic disturbance (p<0.05). : The modified classical technique optimizes surgical efficiency by reducing operative time, anhepatic time, and blood loss compared to the piggyback approach. However, these benefits are offset by a significantly higher incidence of severe hemodynamic instability and post-reperfusion syndrome. Consequently, further technical refinements and enhanced anesthetic strategies are imperative to balance procedural advantages with cardiovascular safety.