The study of anastomoses in liver transplantation represents a complex and special subject considering the fact that a variability of methods have been described since the first liver transplant in 1963, made by Thomas Starzl. În liver transplantation, graft implantation includes 4 anastomoses: cavo-cava, portal, arterial and biliary. The Gordon patch represents the plasty performed between the aortic patch of the celiac trunk and the aortic patch of the superior mesenteric artery. It only applies to anatomical variants of the hepatic artery, namely when the common hepatic artery arises from the celiac trunk and the right hepatic artery arises from superior mesenteric artery.
The present article describes the aspect of the surgical techniques through the experience at the Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania.

In the 1990s a sampling team from the Surgery Department of Saint Luc Clinic in Louvain Brussels, published a study showing that single aortic infusion is as safe as classic, standard infusion (aortic and portal) but the attempt was not fully accepted. Also, some recent studies recommend the safe use of single aortic infusions in the case of multiple organ sampling from the brain-dead donor. In order to test the effectiveness of this method we made a retrospective study between 2017 and 2019 at the Center for General Surgery and Liver Transplantation of the Fundeni Clinical Institute, Bucharest, Romania. First of all, we performed a comparative analysis between the single aortic sampling group and the group in which we used the standard sampling. We also analyzed the impact of singular aortic sampling on cases with anatomical arterial variants.

Background: The purposes of the study were to determine the variations in hepatic arterial supply, to delineate the optimal methods of arterial anastomoses and reconstructions in liver transplantation and to analyse the incidence of arterial complications. Methods: The surgical anatomy of the extrahepatic arterial vascularization was investigated retrospectively in 209 donors and patients who underwent liver transplantation at Fundeni Clinical Institute (Bucharest, Romania) from January 1, 2015 to December 31, 2017. The vascular anatomy of the hepatic grafts was classified according to Michels’ description and other rare variations. Results: Anatomical variants of the classical pattern were detected in 26.3% of the livers (n = 55). The most common variant was a replaced right hepatic artery arising from the superior mesenteric artery (n = 17; 8.13%), followed by a common hepatic artery from superior mesenteric artery (n = 6; 2.87%). Arterial reconstructions were reported in 97 cases (45.5%). In recipients, used sites were intermediate: common hepatic artery (CHA) in 73.8% (n = 158), distal: proper hepatic artery (PHA) or common hepatic artery/gastro-duodenal artery bifurcation (CHA/GDA bifurcation) in 16.4% (n = 35) and proximal: coeliac trunk-splenic artery-aorta (CT–SA–A) in 9.3% (n = 20) of patients. Most common reconstructions were short graft artery (CT) on the recipient CHA (n = 33, 34.02%) and long graft artery: complex reconstruction between CT and superior mesenteric artery (SMA) - accessory right hepatic artery (RHA) from SMA on CHA (n = 12, 12.37%) and right hepatic graft artery on PHA or CHA/GDA bifurcation (n = 16, 16.49%). Conclusion: The information about the different hepatic arterial patterns, as well as establishing specific methods for arterial anastomoses and reconstructions is important in the determination of better outcomes.

Intrahepatic cholangiocarcinoma (ICC) is the second as frequency primary liver cancer after hepatocellular carcinoma (HCC), arising from the biliary epithelium of the second branch (segmental branch) or the proximal branch of bile duct (1,2). Recent reports suggest that the incidence of ICC varies considerably according to geographical location, and accounts for about 5-30% of primary liver cancers, with an increasing incidence during the past years all over the world (3-6). Radical resection (R0) remains the only potential curative treatment, but the resectability rate is still low because of late diagnosis. In general, prognosis is poor, with a reported rate of 5-year survival, usually below 20 to 40% for patients with potentially curative resection (7).
However, the recent progress in anesthesiology and intensive care, the development of more effective surgical techniques in hepatobiliary surgery, and the advent of new devices for parenchymal trans-section made more applicable aggressive surgical approaches for ICC, improving the resectability rate in the last two decades (8,9).

The Romanian Academy of Medical Sciences has been honored to join the College of Physicians of Bucharest in the new series of "Medicina Modern?". Definitely, at this moment Romania needs good medical journals, where our medical scientists could publish. The demand is big, particularly since academic promotions are so much related to the articles published in indexed journals. The offer, unfortunately, is still rather small.
As we all know, it is not easy to get a journal indexed (especially in the ISI web of knowledge) and to keep it at such a high level. That impliesa lot of effort and a very good team. Without a good and efficient team such an endeavor cannot succeed.