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Portal bifurcation reconstruction using own hepatic vein grafts due to portal vein anomaly of the living donor for the patient with portal vein thrombosis

Annals of Hepato-Biliary-Pancreatic Surgery 2020년 24권 4호 p.533 ~ 538
Umemura Akira, Nitta Hiroyuki, Takahara Takeshi, Hasegawa Yasushi, Katagiri Hirokatsu, Kanno Shoji, Kobayashi Megumi, Ando Taro, Kimura Taku, Sasaki Akira,
소속 상세정보
 ( Umemura Akira ) - Iwate Medical University Hospital Department of Surgery
 ( Nitta Hiroyuki ) - Iwate Medical University Hospital Department of Surgery
 ( Takahara Takeshi ) - Iwate Medical University Hospital Department of Surgery
 ( Hasegawa Yasushi ) - Iwate Medical University Hospital Department of Surgery
 ( Katagiri Hirokatsu ) - Iwate Medical University Hospital Department of Surgery
 ( Kanno Shoji ) - Iwate Medical University Hospital Department of Surgery
 ( Kobayashi Megumi ) - Iwate Medical University Hospital Department of Surgery
 ( Ando Taro ) - Iwate Medical University Hospital Department of Surgery
 ( Kimura Taku ) - Iwate Medical University Hospital Department of Surgery
 ( Sasaki Akira ) - Iwate Medical University Hospital Department of Surgery

Abstract


A 57-year-old Japanese female was considered for living donor liver transplantation (LDLT) due to end-stage liver cirrhosis caused by primary biliary cholangitis with portal vein thrombosis (PVT) formation. A 26-year-old daughter of the patient was selected as a living donor; however, a computed tomography examination revealed trifurcated-type portal vein anomaly (PVA). Preoperative liver volumetry showed that the right lobe graft was necessary for the recipient; therefore, reconstruction of the portal vein bifurcation during LDLT was necessary. We planned to extract the recipient’s own hepatic vein grafts after total hepatectomy, and these would be attached with anterior and posterior portal branches as jump grafts. We performed laparoscopic donor hepatectomy as usual, and the recipient’s hepatic vein grafts were anastomosed on the bench. Then, the liver graft was inserted, and the hepatic vein reconstruction was routinely performed. We confirmed the alignment between the recipient’s portal vein and the bridged hepatic vein graft of the liver graft’s posterior branch, and anastomosed these two vessels. Moreover, we confirmed the front flow and expansion of the reconstructed posterior branch by declamping only the suprapancreatic side of the portal vein. The decision regarding the punch-out location was crucial. We confirmed the alignment between the reconstructed posterior branch and the bridged hepatic vein graft of the anterior branch, and anastomosed these two vessels employing the punched-out technique. In LDLT, liver transplant surgeons occasionally encounter living donors with PVA or recipients with PVT. Our contrivance may be useful when the liver graft needs reconstruction of portal vein bifurcation.

키워드

Living donor liver transplantation; Portal vein thrombosis; Portal vein anomaly; Portal vein bifurcation; Interposition graft

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