The impact of standardized methods of hepatic vein reconstruction with an external iliac vein graft

Background:Liver tumors that invade the hepatic vein are surgically challenging,especially in patients with liver dysfunction.Preservation of as much of the parenchyma as possible is important;thus,when feasible,we perform hepatectomy with hepatic vein reconstruction(HVR)using an external iliac vein(EIV)graft.We conducted a retrospective study to investigate the benefit of HVR and to evaluate our procedure.Methods:The study included patients treated by hepatectomy with HVR using EIV grafts and vascular clips.We reviewed the surgical outcomes,including total operation and HVR times,postoperative complications,and postoperative liver function.Results:The surgeries included right HVR(n=13),left HVR(n=3),and middle HVR(n=1).The total operation time was 277±72 minutes(155-400 minutes),and the HVR time was 27±5 minutes(19-40 minutes).Graft patency was confirmed in 14(82%)of the patients.One patient who underwent HVR with running sutures required emergency surgery due to graft thrombosis.Clavien-Dindo>grade IIIa postoperative complications occurred in 4(23.5%)patients,but there were no treatment-related deaths.Conclusions:In conclusion,our hepatic resections with HVR using the same techniques and graft materials showed acceptable surgical outcomes.From our experience,we believe that preparatory hepatic resection with HVR is an effective treatment,especially for patients with decreased liver function or with a small residual liver parenchyma.

Modified techniques for adult-to-adult living donor liver transplantation

BACKGROUND: Because of critical organ shortage, transplant professionals have utilized living donor liver transplantation (LDLT) in recent years. We summarized our experience in adult-to-adult LDLT with grafts of right liver lobe by a modified technique. METHODS: From January 2002 to August 2005, 24 adult patients underwent living donor liver transplantation with grafts of the right liver lobe at West China Hospital, Sichuan University, China. Twenty-two patients underwent modi-Bed procedures designed to improve the reconstruction of the right hepatic vein and the tributaries of the middle hepatic vein by interposing a great saphenous vein ( GSV) graft and the anastomosis of the hepatic arteries and bile ducts. RESULTS: No severe complications and death occurred in all donors. In the first 2 patients, (patients 1 and 2), operative procedure was not modified. One patient suffered from 'small-for-size syndrome' and the other died of sepsis with progressive deterioration of graft function. In the rest 22 patients (patients 3 to 24), however, the procedure of venous reconstruction was modified, and better results were obtained. Complications occurred in 7 recipients including acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left sub-phrenic abscess (1), and pulmonary infection (1). One patient with pulmonary infection died of multiple organ failure (MOF). The 22 patients underwent direct anastomosis of the right hepatic vein to the inferior vena cava (IVC), 9 direct anastomosis plus the reconstruction of the right inferior hepatic vein, and 10 direct anastomosis plus the reconstruction of the tributaries of the middle hepatic vein by in-terpos-ing a GSV graft to provide sufficient venous outflow. Trifurcation of the portal vein was met in 3 patients. Venoplasty or separate anastomosis was performed. The ratio of graft to recipient body weight ranged from 0.72% to 1.17%. Among these patients, 19 had the ratio <1.0% and 4 <0.8%, and the ratio of graft weight to recipient standard liver volume was between 31.86% and 62.48%. Among these patients, 10 had the ratio <50% and 2 <40%. No 'small-for-size syndrome' occurred in the 22 recipients who were subjected to modified procedures. CONCLUSIONS: With the modified surgical techniques for the reconstruction of the hepatic vein to obtain an adequate outflow and provide a sufficient functioning liver mass, living donor liver graft in adults using the right lobe can be safe to prevent the 'small-for-size syndrome'.

Right hepatectomy with preservation of segment VI: Seven cases of preliminary experience

Background:Surgical treatment of tumors near the center of the liver is challenging.Right hemihepatic or triple resection is considered the preferred approach,but it is associated with a high mortality rate due to postoperative liver failure.Therefore,attempts should be made to preserve liver parenchyma to the maximum extent possible.Segment VI of the liver is often excised“innocently”.This article aims to discuss the experience of the right hemihepatectomy with the segment VI preserved.Case presentation:The clinical medical records of 7 patients with right lobe liver cancer who underwent right hemihepatectomy with segment VI preservation during 2015–2021 were collected to selectively reconstruct the right hepatic vein to ensure liver blood return at segment VI.Conclusions:Right hemihepatectomy with segment VI preservation can preserve more liver parenchyma and is a safe and reliable surgical method for patients who need to preserve more liver parenchyma.