Outflow vein reconstruction of extended right lobe graft using quilt venoplasty technique

✍ Scribed by Shin Hwang; Sung-Gyu Lee; Chul-Soo Ahn; Deok-Bog Moon; Ki-Hun Kim; Tae-Yong Ha; Gi-Won Song

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 238 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20574

✦ Synopsis

Various techniques of hepatic vein reconstruction have been created to secure the venous outflow drainage of extended right lobe grafts. They can be roughly classified as follows: unification venoplasty of the right hepatic vein (RHV) and middle hepatic vein (MHV) trunk and corresponding triangular excision of the recipient's inferior vena cava (IVC); large patch venoplasty to accommodate RHV and MHV simultaneously and corresponding large opening at the IVC; and direct RHV anastomosis and separate reconstruction of MHV with or without interposition vein graft. [1][2][3] Any of these reconstruction techniques would ensure the hepatic outflow drainage of right liver graft during the immediate postoperative period unless there was any significant technical fault. However, progressive regeneration of right liver graft would make the liver cut surface shift or rotate toward the ventral and left side. Consequently, this made the MHV and its anastomosis vulnerable to morphologic distortion. This mechanism has been presented by the Hong Kong group and Tokyo groups. 1,4 We analyzed the regeneration patterns of extended right lobe grafts, and reproduced the 3-dimensional distortion of MHV anatomy through computer simulation. We recognized that interposition of redundant vascular cuff around the orifices of graft RHV and MHV is beneficial to offset such a regeneration-induced distortion.

However, a large-sized vein patch is not always available in Korea, where cadaveric donors are scarce. Instead, we began to applying the quilt venoplasty technique using an autologous saphenous vein patch. 5 A new dome-shaped vein cuff was attached to the RHV and MHV orifices of an extended right lobe graft (Fig. 1). At the same time, the orifices of recipient's RHV, MHV, and left hepatic vein were opened altogether to make a large orifice at the recipient IVC (Fig. 2).