Reconstruction of middle hepatic vein using a rotating left hepatic vein flap.

Abstract

S A m t n i i t t v d A f o c t S d v a v T s d t r c t i a f M L f he middle hepatic vein (MHV) drains the central part f the liver, including approximately two-thirds of the ight paramedian sector. In patients with a very thick HV, the MHV may drain an even larger part of the ight liver, including the caudal part of the right lateral ector. After a left hemihepatectomy including the HV (extended left hepatectomy), a considerable part f the remnant right liver becomes congested and may radually shrink postoperatively. This surgical proceure is sometimes used for the treatment of liver metasases from colorectal cancer, such as for patients in hom the tumor has invaded the confluence of the HV and left hepatic vein (LHV). Because the right iver constitutes 60% to 70% of the total liver parenhyma, most patients with normal liver function can olerate an extended left hepatectomy, even if most of he right paramedian sector becomes congested. When he possibility of future multiple liver resections or a epeat liver resection for an intrahepatic recurrence inolving the right hepatic vein is considered, reconstrucion of the MHV so as to preserve as much of the reaining liver function as possible becomes highly esirable. Repeat liver resections requiring the sacrifice f the right hepatic vein cannot be performed if the HV is not reconstructed during the first hepatectomy. n extended left hepatectomy sacrificing the MHV may e risky in patients with liver cirrhosis or other liver iseases. To reconstruct the MHV in this setting, we have deeloped a simple new technique for venous reconstrucion in which an LHV flap is rotated to reconstruct the HV after performing an extended left lobectomy or