*Purpose: The reconstruction of hepatic artery (HA) is most complex step in living donor liver transplantation (LDLT) due to smaller diameter of the artery and increased risk of HA related complications. Due to smaller diameter of the HA, many centres use microsurgical technique with interrupted sutures for HA reconstruction. The aim of our study was to retrospectively investigate the outcomes after HA reconstruction under magnifying loupes using parachute technique.

*Methods: From August 2002 to 31^st December 2018, LDLT was performed in 1025 recipients. The reconstruction of the HA was subgrouped in 2 eras depending upon the initial experience and the use of microsurgery technique for the anastomosis (Figure 1).

Era I- (August 2002-April 2007) 25 LDLT surgeries were performed in these period and HA anastomosis was performed under operating microscope. Era II- (May 2007- December 2018) HA reconstruction was achieved by using our present standard technique under surgical loupes. HA reconstruction was performed using a continuous, single-stitch, running suture with the parachute technique.

*Results: The HA anastomosis was unusually prolonged > 60 minutes for all the patients in Era I. 2 patients expired in this era directly related to HA complications in post-transplant period. The most notable factor in Era II was the quick HA reconstruction procedure with a mean time of 10 ± 5 minutes (range: 5-30 minutes). The hepatic artery thrombosis (HAT) was diagnosed in 8% (n=2) of patients in Era I whereas the HAT rate was 1.3% (n=13) in Era II using magnifying loupes (Table 1).

*Conclusions: HA reconstruction by parachute technique using magnifying loupes is a feasible in adult-to-adult LDLT. A speedy reconstruction can be performed by experienced surgeons with a very low incidence of HAT.

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