Background: Liver transplantation (LT) continues to evolve with techniques aimed at minimizing perioperative complications associated with caval and portal vein clamping. Caval-sparing approaches, such as the piggyback technique, preserve hemodynamic stability; however, portal clamping remains necessary and may trigger postreperfusion syndrome, endotoxemia, and hepatic microcirculatory disturbances. Temporary portocaval shunts (PCSs) have been developed to maintain portal flow during LT, mitigating these adverse effects and allowing for hemodynamic stability and a reduced intraoperative bleeding. Portocaval Shunts: Various PCS techniques—including end-to-side, right-branch, portosaphenous, mesenterico-saphenous, iliac-venous conduit interposition, portoumbilical, and Rex-saphenous shunts—allow an individualized approach based on patient anatomy and surgical complexity. Review of Evidence: Available evidence demonstrates that PCS improves intraoperative hemodynamic stability, reduces blood transfusion requirements, and preserves renal function, particularly in patients with high portal flow or severe portal hypertension. PCS may also shorten warm ischemia time, facilitate hepatectomy, and enhance outcomes in extended criteria donor grafts or marginal organs. Meta-analyses and randomized studies support its role in reducing intraoperative blood loss, improving early graft function, and accelerating postoperative recovery. However, the effect of PCS on long-term survival and major postoperative morbidity remains variable, likely due to heterogeneity in patient populations, donor types, and perioperative management. Conclusions: Overall, PCS represents a safe and feasible adjunct in LT, offering significant hemodynamic and technical advantages. Its use should be individualized based on patient risk factors, intraoperative hemodynamics, and anticipated intraoperative challenges. PCS provides a practical strategy to preserve portal flow, minimizing intraoperative complications and facilitating the hepatectomy. However, the decision to create a PCS during LT still depends on the surgeon’s preference. Postoperative outcomes and impact on long-term survival require further investigation.

Background and Objectives: Psychological resilience is increasingly recognized as a determinant of how patients respond to surgical stress, yet its role in perioperative medicine remains poorly defined. This narrative review aims to synthesize current evidence on resilience in surgical populations from a psychobiological perspective, spanning conceptual models, measurement approaches, clinical correlates, biological mechanisms, and intervention strategies. Materials and Methods: This narrative review was conducted to examine psychological resilience in adult surgical populations from an integrated psychobiological and perioperative perspective. A structured literature search was performed in December 2026 using PubMed, Scopus, and PsycInfo, combining resilience-related constructs with surgical, perioperative, biological, and clinical outcome keywords. Eligible publications included observational, longitudinal, interventional, translational, and conceptually relevant studies addressing resilience in adult surgical settings. Evidence was synthesized qualitatively across predefined domains, including conceptualization and measurement of resilience, associations with perioperative outcomes, neuroendocrine and inflammatory mechanisms, and resilience-modulating interventions within perioperative and Enhanced Recovery After Surgery (ERAS) frameworks. Results: Contemporary models conceptualize resilience as a dynamic, context-dependent process supported by interacting psychological, biological, and social factors. In surgical cohorts, higher resilience is consistently associated with better patient-reported outcomes, including quality of life, pain control, and emotional adjustment, and in some studies with survival and functional recovery. Preoperative depression, anxiety, maladaptive coping, and low social support converge as components of a broader “resilience profile” linked to poorer postoperative trajectories. Biologically, resilient phenotypes are characterized by more regulated hypothalamic–pituitary–adrenal and autonomic responses and reduced inflammatory activation. Psychological therapies, prehabilitation programs, and selected pharmacological strategies show convergent, though heterogeneous, signals of benefit and can be interpreted as indirect resilience-enhancing interventions. Conclusions: Resilience appears to be a clinically meaningful, potentially modifiable construct that links psychosocial functioning, biological vulnerability, and postoperative outcomes. Incorporating resilience assessment into preoperative risk stratification and systematically embedding resilience-building strategies within perioperative and ERAS pathways may support more personalized, psychologically informed surgical care. Prospective, multidomain studies are needed to validate measurement tools, clarify mechanisms, and test resilience-targeted interventions in surgical populations.