Portal Vein Variations Research Articles

Study of the human liver by ultrasound examination to search for variations of venous anatomy.

Knowledge about venous patterns (especially portal and hepatic venous) and their variations are extremely crucial for liver transplantation and other surgical procedures on liver. Studies have been done at national or international level on variations of hepatic venous patterns by CT or MRI or by dissection on cadaveric liver. No definitive or authentic study on this topic could be noted in electronic and print media, as well as in standard textbook. Considering low cost and noninvasive nature, we utilized ultrasonography to bridge this lacuna. To estimate prevalence and types of anatomical variations of hepatic venous system and to determine association of among variations. It is an observational cross-sectional study where ultrasonographic evaluation of hepatic venous pattern on adult population of either sex (consecutive sampling) without any major liver disorders was done in RG Kar Medical College and data were analyzed with appropriate statistical procedures. Normal hepatic venous pattern along with normal portal venous pattern is much higher in our study, which is a unique finding. The proportion of normal portal venous pattern is more in extra hepatic bifurcation group. Variations of portal vein and normal hepatic venous pattern are more in case of intrahepatic bifurcation of portal venous branching group. Overall presence of intrahepatic bifurcation of portal vein is significantly higher than extrahepatic bifurcation. This study provides an updated database for the prevalence and distribution of anatomic variations of the hepatic venous and portal venous system.

Application value of three-dimensional reconstruction in preoperative evaluation of precise hepatectomy for complex primary liver cancer

Objective: To explore the application value of three-dimensional reconstruction of liver based on computer software in preoperative evaluation of precise hepatectomy for complex primary liver cancer. Methods: The clinical data of patients in Peking University People's Hospital Hepatobiliary surgery with complicated primary liver cancer from September 17, 2019 to December 20, 2020 were analyzed retrospectively. Preoperative enhanced CT/MR data of patients were collected, and 3D reconstruction of liver was performed in IQQA􀳏-3D Liver system. The liver volume of patients was calculated, the size and location of tumor were described, and the relationship between tumor and intrahepatic bile duct, portal vein, hepatic artery and inferior vena cava was described. Preoperative decision-making and treatment plan were made to compare the compliance of the actual operation plan with the planned operation plan under the guidance of three-dimensional reconstruction. Results: Among all 10 patients, there were 6 males and 4 females, aged 36 to 75 years. There were 6 cases of Child-Pugh grade A and 4 cases of B liver function. There were 5 cases of portal vein variation and 5 cases of hepatic artery variation. The range and M(Q1,Q3)of actual liver volume measured by 3D reconstruction in 10 patients was 895- 2 477 cm3 and [1 444(1 001, 1 854)] cm3;the nodule volume was 7-1 808 [133(50, 566)] cm3;the nodule volume in the liver was 0.8%-73.0% [11.0(3.3,32.7)]% and the number of suspected lesions was 1-7. In the end, 6 patients received surgical treatment;3 received chemotherapy, and 1 received conservative treatment. The preoperative three-dimensional reconstruction of liver anatomy and tumor location of the patients receiving surgical treatment were basically consistent with the intraoperative situation. There was no case of liver failure or death during perioperative period. Conclusion: In the preoperative evaluation of precise hepatectomy for complex primary liver cancer, 3D reconstruction can improve the rationality of treatment and the surgeon's understanding of the anatomical characteristics of the liver, so as to select the best treatment for patients, which has great application value.

Evaluation of variation of portal vein branching pattern on Multidetector Computed Tomography in adult population

Introduction: The main aim of this study was to determine the prevalence of main and right portal vein variation in study population and evaluate their branching patterns on abdominal CT. Methods: A hospital based cross sectional study was carried out in Department of Radiology, BPKIHS over a period of 6 months after taking ethical approval from institutional review committee. 375 cases referred for abdominal CT for various indications were included in the study. Results: Classic main portal vein branching pattern (Type 1) was identified in 305 (81.3%) cases. Main portal vein branching variations were identified in 70 (18.7 %) cases of which most common variation was trifurcation pattern (Type 2) seen in 48 (12.8%) cases followed by right posterior portal vein as first branch of main portal vein (Type 3) seen in 21 (5.6%) cases. Out of 305 cases with Type 1 branching pattern, classic branching pattern of right portal vein was noted in 285 (93.4%) cases. Right portal vein variations were identified in 20 (6.5%) cases. Common variations of right portal vein noted in our study were early origin of segment VlI branch from right portal vein seen in 5 cases (1.6%), early origin of segment VI branch from right portal vein seen in 4 (1.3%) cases and quadrifurcation pattern seen in 3 cases (0.98%). Conclusion: Prevalence of portal vein variations is high on routine abdominal CT scans. Knowledge about branching patterns of these variations can be useful to reduce liver injury and complications during hepatic surgeries and interventions.

Laparoscopic living donor right hepatectomy regarding the anatomical variation of portal vein: A propensity score matched analysis

This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases with right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were three-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce, selection bias, 1:1 ratio propensity score match analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcome as well as portal vein complication-free survival, graft survival and overall survival were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had shorter operation time (p < 0.001), smaller number of additional opioids required by the donor (p < 0.001), shorter hospital stay (p < 0.001). There were no difference in the portal vein complication-free survival (p = 0.16), graft survival (p = 0.26), and overall survival (p = 0.53). While portal vein complication-free survival was inferior in portal vein other than type I (p = 0.01), the laparoscopy showed similar portal vein complication-free survival whether the portal vein was type I (p = 0.35) or other types (p = 0.30). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of portal vein.

Stepwise development of robotic donor right hepatectomy according to the anatomical variations in the hilum and the graft volume

Initial strict selections of donor without anatomical variations are recommended for minimally invasive living donor liver transplantation (LDLT) program because the donor safety is the most paramount. In this study, we introduced our stepwise development of robotic donor LDLT from donors with from favorable to unfavorable anatomies. From Apr. 2016 to Oct. 2020, 80 donors received robotic donor right hepatectomy. All donors were divided according to the variations of the portal vein and bile duct and the graft volume (> 800 cc). Donors who had at least one variable that satisfy beyond the three extended criteria were defined as 'unfavorable group'. The proportion of variations was analyzed according to the four periods and perioperative outcomes were compared between favorable and unfavorable group. Among 80 cases, portal vein variation and bile duct variation were observed 10 cases and 22 cases, respectively. Donors who had graft weight more than 800 g were 22 cases. Unfavorable group donors were 8 cases in 1st and 2nd period, respectively. In 3rd period, 9 donors were unfavorable group. In recent 20 cases, 14 donors were unfavorable group. Comparing the perioperative outcomes between favorable and unfavorable group, there were no significant differences regarding total operative time, warm ischemic time, estimated blood loss and postoperative complication. Stepwise development of robotic donor right hepatectomy showed comparable perioperative outcomes in donor with the anatomical variations in the hilum and larger graft volume and seems to a reasonable way for a safe and successful minimally invasive LDLT program.

Pure laparoscopic living donor hepatectomy for the right posterior segment graft

The right posterior segment (RPS) graft was introduced as an alternative to expand donor pool. The first LDLT case using an RPS graft was reported in 2001, the RPS graft has not been widely used in LDLT because of lack of donors with suitable anatomical variation, technical challenge for safe donor hepatectomy and surgical difficulties in recipient operation. We present the 3 cases of pure laparoscopic donor hepatectomy with RPS graft. For donor evaluation, we performed laboratory test, abdominal ultrasonography and dynamic computed tomography (CT) scan. Graft selection was determined based on volumetric analysis. In 3 cases of RPS graft, the ratio of the remnant liver volume/whole liver volume was less than 0.3 and left lobe graft was small for metabolic demand of recipients. All 3 donors had type 3 portal vein variation. The Graft Recipient Weight Ratio (GRWR) was 0.72, 0.81, and 1.34 in each case. Preoperative magnetic resonance cholangiopancreatography (MRCP) was performed to evaluate bile duct anomaly. In 3 cases, we had no open conversion, intraoperative and postoperative transfusion. Cut surface bile leakage occurred in one case, but bile leakage decreased without procedure or intervention, the donor discharged at postoperative day 9. He had no more complications. Recipients were recovered uneventfully and discharged. To meet the donor's safety and recipient's metabolic demand, graft selection is one of the important factors in LDLT, the RPS graft is an alternative to expand donor pool. However, thorough preoperative evaluation to understand the anatomical variation is necessary even for experienced transplant surgeons.

Portal venous and hepatic artery hemodynamic variation in non-alcoholic fatty liver disease

BackgroundNon-alcoholic fatty liver disease remains asymptomatic until advanced disease, when risk factor modification and available treatment become no longer effective. Studies on hepatic vasculature can be informative about parenchymal injury and disease severity through the study of changes affecting vascular compliance. This study aimed to study portal vein and hepatic artery hemodynamic variation in non-alcoholic fatty liver and to correlate it with disease severity.ResultsThis case control study included 80 participants; those were further divided into four groups; healthy volunteers and non-alcoholic fatty liver disease patients’ grade 1, 2, and 3. We did anthropometric measures, laboratory tests, transient elastography, and Doppler ultrasound for all participants, and then we collected the data and analyzed it using SPSS version 25.Doppler findings showed that peak maximum velocity, peak minimum velocity, mean flow velocity, portal vein pulsatility index of portal vein, and hepatic artery resistivity index were significantly lower in non-alcoholic fatty liver disease patients than in healthy people. All indices were indirectly proportionate to the grade of the disease except for peak minimum velocity which was significantly lower on comparing grade 3 patients with grades 1 and 2 patients.ConclusionsReduction of portal flow and increase in hepatic artery flow in fatty liver correlates with disease severity and can help as a non-invasive measure in diagnosis and grading of non-alcoholic fatty liver disease.

Laparoscopic Living Donor Right Hepatectomy Regarding the Anatomical Variation of the Portal Vein: A Propensity Score-Matched Analysis.

This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases using a right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were 3-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce selection bias, a 1:1 ratio propensity score-matched analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcomes as well as portal vein complication-free survival, graft survival, and overall survival rates were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had a shorter operation time (P<0.001), a smaller number of additional opioids required by the donor (P<0.001), and a shorter hospital stay (P<0.001). There were no differences in the portal vein complication-free survival (P=0.16), graft survival (P=0.26), or overall survival rates (P=0.53). Although portal vein complication-free survival was inferior in portal veins other than type I (P=0.01), the laparoscopy group showed similar portal vein complication-free survival regardless of the anatomical variation of portal vein (P=0.35 in type I and P=0.30 in other types). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of the portal vein.

Clinical Importance of Main Portal Vein and Right Portal Vein Variations: A Prevalence Study With 128-Slice Multidetector Computed Tomography.

The portal vein variation type significantly affects the outcome of transplant surgery, hepatectomies, and interventional radiological procedures. To reveal variation types, especially rare types, we used high-technology multidetector computed tomography. We evaluated multiphase abdominal multidetector computed tomography scans of 278 consecutive patients. Multidetector computed tomography scans were processed for axial, coronal, and axial-oblique multiplane reformation and for maximum intensity projection. Variations of the main portal vein and right portal vein were simulta-neously analyzed by 2 radiologists. Prevalence of each variation and differences in sexes were investigated. Variant anatomy was detected in 29.5% of main portal veins and 20.9% of right portal veins. There was no statistical difference between sexes. Type 3 was reported as the most frequent variant of main portal vein, whereas type 4 was the most frequent variant of right portal vein. Some miscellaneous types were also ascertained. Different types of anatomic variations may adversely affect the course of surgery and interventional radiological procedures. Fortunately, radiologists can now discover the critical types by using the new generation multidetector computed tomography with 3-dimensional reconstruction techniques. This information should be included in the radiology reports of patients who are scheduled for major surgery.

First two-stage robotic ALPPS in HCC patients with hepatic vein invasion: a step-by-step procedure from a clinical case

BackgroundThe associating liver partitioning and portal vein occlusion for staged hepatectomy (ALPPS) procedure is gaining interest because it brings hope to patients who cannot undergo radical surgical resection due to insufficient remnant liver volume. However, the indications and technical aspects of this procedure are still under debate. This report demonstrates the technical aspects of the first two-stage robotic ALPPS for HCC.Case presentationA 55-year-old man with type II portal vein variation was diagnosed with hepatocellular carcinoma. Preoperative 3D reconstruction of the liver based on CT showed a future liver remnant/standard liver volume (FLR/SLV) of 24.45%. The ALPPS procedure was performed using the da Vinci Si system. At the first stage of the operation, we removed the gallbladder and ligated the right anterior branch of the portal vein and the right posterior branch. Following blocking of the hepatic hilum, the liver parenchyma was removed 1 cm away from the right side of the falciform ligament in an incision manner from the top to the bottom and from shallow to deep. The second-stage operation was performed on the 12th postoperative day with a FLR/SLV of 45.13%. During this step, the right hemiliver plus left medial section was separated and removed. Postoperative pathology showed a negative margin. The operative times were 195 and 217 min, respectively. Estimated blood loss was 250 and 500 ml, respectively. There was no need for transfusion or hospitalization in intensive care. The patient was discharged on the 6th postoperative day. Recovery was uneventful after both stages, and the patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. The patient had no evidence of the disease 14 months after the procedure.ConclusionsThe two-stage robotic ALPPS procedure is a safe and feasible technique for select patients with HCC.

Morphometric Characteristics of the Portal Vein According to Multispiral Computed Tomography

The article discusses the variability of the linear dimensions of the portal vein depending on gender and age. In modern foreign and Russian literature, there is no uniform information about the variant portal vein anatomy. Data on the extreme forms and on the range of anatomical differences in the portal vein vary considerably. All this requires the need for a more detailed study of the morphometric characteristics of the portal vein branch. Computed tomography, in contrast to dissection on a corpse, allows an in vivo study of various morphometric characteristics of the portal vein.The aim of the study is to identify patterns of variability in the linear dimensions of the portal vein in persons of different sex and age.Material and methods. The study material consisted of multispiral computed tomography images of the abdominal cavity with contrast enhancement taken in 100 patients. The study included results of 56 men and 44 women, divided into 4 age groups: 1) first mature age, 2) second mature age, 3) the elderly, 4) the senile. The length of the portal vein was measured between the angle formed at the junction of the superior mesenteric and splenic veins and the angle formed by the branches of the portal vein at the hepatic hilum. The diameter of the vessel was measured at the midpoint of the distance between the proximal and distal points.Results. The length of the portal vein in the general sample was 66.45±8.49 mm, and its diameter was 11.84±1.93 mm. In women, the length of the portal vein was 64.37±6.6 mm, and its diameter was 11.33±1.83 mm, respectively. In men, both the length and diameter of the black vein were significantly greater than in women and constituted 68.09±9.4 mm and 12.24±1.91 mm, respectively. No statistically significant correlation of the studied parameters with age was detected.

Radiological Study of Portal Vein Variations and its Morphometry with Special Reference to its Surgical Implications of Liver

Radiological Study of Portal Vein Variations and its Morphometry with Special Reference to its Surgical Implications of Liver

Role of multidetector computed tomography (MDCT) in evaluation of main and right portal vein branching patterns and its clinical significance

Introduction: Knowledge of the normal portal vein anatomy and its variations is imperative for various hepatic interventional procedures and liver surgeries like during creation of transjugular intrahepatic portosystemic shunt (TIPS), partial hepatectomy and Liver transplantation. Aims and Objective: The aim of our study was to determine and analyse the spectrum of variations in the main and right portal vein anatomy and their prevalence in Indian population using MDCT. Materials and Methods: Triple phase abdomen CT of 688 patients done on a 64 slice MDCT scanner between February 2012 and March 2014, were retrospectively evaluated by two radiologists independently. Out of these, 500 patients met the inclusion criteria. Axial images of portal and venous phase along with the maximum-intensity-projection and volume rendered images were reviewed and branching patterns of main and right portal vein were recorded. Results: Normal portal vein anatomy was present in 67% of the patients. Main portal vein (MPV) variations were seen in 15.2% of the patients. The most common variant was Z-type pattern (7.6%). Next common was trifurcation pattern (6.6%). Right portal vein (RPV) variations were seen in 17.8% of patients and the most common pattern was early segmental branching (6.8%). Other RPV branching variations were RPV trifurcation (3.6%), RPV quadrification (3.6%), and superior-inferior division (1.4%). Miscellaneous branching variations of RPV were seen in 2.4% of all patients. Conclusion: Variations in the main portal vein and right portal vein anatomy are quite common and can be clearly detected with MDCT. Keywords: Portal vein branching, Portal vein MDCT, MPV variation, RPV variation.

Pure laparoscopic versus open right hepatectomy in living liver donors: which is longer bench-surgery time

Background: The aim of the study was to measure bench-surgery time in pure laparoscopic donor right hepatectomy (PLDRH) in comparison with those of conventional donor right hepatectomy (CDRH). Methods: We retrospectively reviewed the medical records of 514 donors who underwent living donor liver transplantation be tween January 2012 and December 2019 at Seoul National University Hospital. We divided it into two periods: when almost only CDRH was performed and the second period during which PLDRH was standardized. Results: The mean bench-surgery time (49.3 vs. 39.5 minutes; P=0.00) was longer in the PLDRH group than the CDRH group. We performed the analysis while excluding the factors affecting the bench-surgery time in both groups. First, we analyzed except the patients who had undergone direct venoplasty or Y-graft patch reconstruction of two portal veins. After that, we excluded the pa tients who had reconstruction of more than three openings of middle hepatic vein tributaries and no reconstruction of those (right hemi-liver graft). Lastly, we excluded the patients who underwent venoplasty of inferior hepatic vein(s) in back-table procedures. In all three subgroup analyses, the mean bench-surgery time was also longer in the PLDRH group than the CDRH group (47.4 vs. 38.4 minutes, P=0.00; 48.7 vs. 37.4 minutes, P=0.00; 48.3 vs. 36.6 minutes, P=0.00). Conclusions: The bench-surgery time takes longer in the PLDRH group regardless of reconstruction of type II or III portal vein variations and liver graft outflow or not.

Role of CT Imaging With Three-Dimensional Maximum Intensity Projection Reconstruction in the Evaluation of Portal Vein Variants at a Tertiary Care Hospital

Introduction: Portal vein (PV) is the principal blood vessel transporting blood from the alimentary tract and spleen to the liver. The aim of this study is to determine the prevalence of PV anatomical variations in our population using multidetector CT with maximum intensity projection (MIP) technique at a tertiary care hospital.Methods: This cross-sectional study was prospectively conducted from November 2018 to June 2019 in the Department of Radiology at a tertiary care hospital in Karachi. After informed consent, all the patients with no known hepatic pathology undergoing routine abdomen CT were included in this study. Patients with previous hepatic resection surgeries, undiagnosed large hepatic tumors/metastasis, and those with PV thrombosis were excluded.Results: A total of 500 patients (256 males and 244 females) were included in the study; the mean age of female patients was relatively higher as compared to the male patients (53.80 ± 18.44 vs. 44.15 ± 19.94 years; p = 0.000). Standard PV anatomy (type 1) was found in 438 patients (87.6%). Trifurcation (type 2) occurred in 18 patients (3.6%). Right posterior portal vein as the first branch of main PV (type 3) was found in 22 patients (4.4%). A separate branch of the right portal vein (RPV) to segment VII (type 4) and separate branch of the RPV to segment VI (type 5) were found in 6 (1.2%) and 16 (3.2%) patients, respectively.Conclusion: Our study displayed a relatively higher frequency of standard PV anatomy (type 1) compared to previous studies. We highlight the role of MIP in the analysis of hepatic venous anatomy with its utility demonstrating improved detection of variations.

Evaluation of portal vein variations in multidetector CT

Aim: It is important for surgeons to have a comprehensive knowledge of vascular anatomy when performing liver interventions. For example, liver transplantation requires a vast understanding of vascular anatomy and variations. This study aimed to evaluate the intrahepatic branching pattern of the portal vein to find out unknown variations. Methods: Multidetector computed tomography images of the abdomen region were used from the PACS archives of Selcuk University Medical Faculty Hospital. Images of 838 patients (464 females and 374 males) who had no hepatic pathologies were examined. Images were evaluated in terms of the presence of variations, and the cases were divided into groups, all of which were compared in terms of gender. Results: A previously unknown variation of the portal vein was detected in 4.9% of the patients: The left portal vein curved reversely after its origination from the main portal vein, supplying liver segments II and IV, after which it branched to supply segment III. In addition, four types of previously known variations of the portal vein were detected. Normal anatomic branching of portal vein was detected in 82.6% of the patients. Conclusion: A previously unknown variation was detected. Awareness of this variation and other known variations is significant in hepatic transplantation, surgery, and interventions.

Hepatic vascular variations and visual three-dimensional reconstruction technique in pediatric patients with choledochal cyst

The aim of the present study was to identify the hepatic vascular variations with visual three-dimensional (3D) reconstruction of vessels in pediatric patients with choledochal cyst (CDC). We retrospectively analyzed the data of 84 children with pathologically confirmed CDCs treated in the Children's Hospital of Soochow University. 180 patients without CDCs as a control to analysis the hepatic artery and portal vein anatomy. All patients were examined by multi-slice spiral CT (MSCT) and the images of children with CDC were reconstructed by Hisense computer-assisted surgery system (Hisense CAS) to obtain visual 3D images. There were 71 females and 13 males diagnosed with CDC. According to Todani classification of CDC, there were 42 cases of type Ia, 10 cases of type Ic and 32 cases of type IVa. There were 10 (11.9%) patients with hepatic artery variations, 14 (16.7%) patients with right hepatic artery located on the ventral side of the CDC, and 16 (19.0%) patients with portal vein variations. Sex, age and types of the cyst were not associated with the presence of vascular variations. There was no significant difference in hepatic vascular variation between CDCs and control groups. Visual 3D images clearly displayed the hepatic vascular variations and the spatial structure of the CDC in pediatric patients with CDC. Hepatic artery and portal vein variations can be detected in pediatric patients with CDC. Visual 3D technique can visually and stereoscopically display the anatomical variations of the hepatic artery and portal vein.

Application of 3D visualization and 3D printing in individualized precision surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma

To explore the application of 3D visualization and 3D printing in individualized precision surgical treatment of Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma. We retrospectively analyzed the data of 10 patients with hilar cholangiocarcinoma undergoing surgeries under the guidance of 3D visualization and 3D printing in the Department of Hepatobiliary Surgery, Zhujiang Hospital from May 2016 to March 2019. Thin-section CT data of the patients were collected for 3D reconstruction and 3D printing, and the 3D printed models were used for observing the 3D relationship of tumor with the intrahepatic bile duct, hepatic artery, portal vein and hepatic vein system and for performing preoperative simulated surgery and surgical planning. The 3D printed models were subsequently used for real-time intraoperative navigation to guide surgeries in the operating room. 3D visualization models were successfully reconstructed for all the 10 patients and printed into 3D models. The 3D visualization types in Bismuth-Corlette classification included type Ⅲa (4 cases), type Ⅲb (4 cases), and type Ⅳ (2 cases); 4 patients showed portal vein variation, 3 had hepatic artery variation, and 2 had both portal vein and hepatic artery variations. Two patients were found to have trifurcation type of portal vein variation, one had "I-shaped" variation, and one showed the absence of the right anterior branch of the portal vein; 3 patients had hepatic artery variations with the left hepatic artery originating from the left gastric artery (1 case) and the right hepatic artery originating from the superior mesenteric artery (2 cases). Four patients with type Ⅲb underwent left hepatectomy; 4 with type Ⅲa received right hepatectomy; 1 patient with of type Ⅳ received peripheral hepatic resection and another underwent left hepatectomy. The results of preoperative 3D reconstruction, 3D printed model and preoperative planning were consistent with the intraoperative findings. The operative time was 452±75.12 min with a mean intraoperative blood loss of 356±62.35 mL and a mean hospital stay of 15 ± 4.61 days in these cases. One patient had bile leakage and 3 patients had pleural effusion postoperatively, and they were discharged after drainage and medications. No liver failure or death occurred in these cases perioperatively. 3D visualization and 3D printing can facilitate accurate preoperative assessment, surgical planning and surgical procedure optimization for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma to improve surgical safety and reduce surgical risks especially in cases of intrahepatic vascular variations.

Biliary Complications After Single- and Dual-Graft Living-Donor Liver Transplantation Using a Right Posterior Section Graft of Donor with a Type III Portal Vein Variation

BackgroundWhen the donor’s left lobe volume is <30%, donor selection for the right posterior section graft (RPSG) is based on the type III portal vein (PV) anatomic variation. Herein, we validated the selection of a donor with a type III PV variation for RPSG to prevent biliary complications (BCs) after single-graft (SG) and dual-graft (DG) living-donor liver transplantation (LDLT). MethodsThe clinical data of recipients and donors with a type III PV variation for LDLT using an RPSG performed between January 2004 and June 2018 were retrospectively collected and analyzed to determine the occurrence of BCs. ResultsThe 26 LDLTs performed using an RPSG, including 20 DG LDLT cases, accounted for 0.6% of all LDLT cases (n=4292). BCs developed in 6 recipients (23.0%), including biliary stricture in 4 (15.3%) and bile leakage in 2 (7.6%). No vascular complications occurred. The RPSG volume was significantly smaller in recipients with BCs than in those without BCs (400.8±79.9 vs 504.1±96.5 mL, P = .015). The bile duct types were A, B, C1, C2, and D in 6 (18.8%), 5 (15.6%), 3 (9.4%), 13 (40.6%), and 5 (15.6%) patients, respectively. All the RPSGs had a single-orifice bile duct. The bile duct size of the RPSG was relatively smaller in recipients with BCs than in those without BCs (2.8±1.0 vs 3.6±1.4 mm, P = .237). ConclusionsWhen the left liver volume is disproportionately small, selection of a donor with a type III PV variation can prevent BCs after SG and DG LDLTs using an RPSG.

Variations of the right branch of hepatic portal vein in children based on three-dimensional simulation technology.

To study the variations of the right branch of the hepatic portal vein in children. A total of 810 children's abdominal CT images were reconstructed with three-dimensional (3D) simulation software, Variations of the right branch of the hepatic portal vein were analyzed and classified. The most common anatomy (type A) was seen in 355 patients (43.83%). Trifurcation in the right anterior portal vein (type B) variation was seen in 250 cases (30.86%). The right posterior portal vein arched without obvious branching (type C) was seen in 71 cases (8.77%). There were 134 special variants (16.54%) named type D, including 14 cases (1.73%) with the right anterior branch in four sub-branches, 13 cases (1.60%) in one trunk and multiple sub-branches, 92 cases (11.36%) originating from the left trunk of the portal vein, and 15 cases (1.85%) with the VI segment of the portal vein originating from the right anterior branch of the portal vein. Variations in the right branch of the hepatic portal vein seems to be very frequent. Recognition of such variations is important in the preoperative evaluation of children with surgery planned, because these variations may have implications for anatomy-guided liver resection and for planning the operative approach.