Abstract
Background: Since being described by Belghiti in 2001, the liver hanging maneuver for anterior resection is widely used. A literature review shows a success rate greater than 90%. Various devices such as a 10Fr nasogastric tube and a Penrose drain have been utilized for lifting the liver. We sought to determine the appropriate size of the hanging tapes by measuring the size of the retro-hepatic avascular space in cadaveric livers. Methods: Forty three adult cadavers were used in this study, preserved in 10% formaldehyde. After entering the abdominal cavity, the entire liver, along with the retro-hepatic vena cava, the hepatic artery, the portal vein and the bile duct, was removed, as is performed in harvesting the liver for transplantation. The vena cava was opened posteriorly “ex vivo” and the proper and short hepatic veins examined from the inside. The size of the retro-hepatic avascular area was measured. Results: The distance between the hepatic veins in the retro-hepatic avascular space ranged from 3 to 19 mm in width, with a median of 7 mm. The liver hanging maneuver was deemed feasible in almost 80% of the specimen that had 5 mm or greater distance. In ten specimens measuring 4 mm or less, however, suture ligation of the caudal short hepatic veins seemed necessary before passing a tape. Conclusion: The retro-hepatic avascular space is 5mm or larger in a majority of specimens examined and the size of the hanging tape should be selected accordingly.
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