Porto-Rex Shunt for Left Portal Vein Reconstruction During Right Extended Hepatectomy for Advanced Extrahepatic Biliary Cancer

Resection offers the only chance of long-term survival or cure for perihilar cancer, provided R0 resection is achieved with margin-negative status of the remnant liver, bile duct, proximal hepatic artery, and portal vein. End-to-end anastomosis of the portal trunk to the left portal branch is the co...

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Bibliographic Details
Published inWorld journal of surgery Vol. 43; no. 4; pp. 1117 - 1120
Main Authors Lahat, Eylon, Jaber, Ahmad, Salloum, Chady, Lim, Chetana, Golan, Gil, Ben-Ari, Ziv, Gutman, Mordechai, Azoulay, Daniel
Format Journal Article
LanguageEnglish
Published Cham Springer International Publishing 15.04.2019
Springer Nature B.V
Subjects
Abdominal Surgery
Anastomosis
Anastomosis, Surgical - methods
Bifurcations
Bile
Bile Duct Neoplasms - surgery
Bile ducts
Bile Ducts, Extrahepatic - surgery
Blood Vessel Prosthesis Implantation - methods
Blood vessels
Cancer
Cardiac Surgery
Female
Fragility
General Surgery
Hepatectomy
Hepatectomy - methods
Hepatic artery
Hepatic Artery - surgery
Humans
Innovative Surgical Techniques Around the World
Kinking
Liver
Male
Medicine
Medicine & Public Health
Middle Aged
Portal vein
Portal Vein - surgery
Surgery
Thoracic Surgery
Treatment Outcome
Twisting
Vascular Surgery
Veins & arteries
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Summary:Resection offers the only chance of long-term survival or cure for perihilar cancer, provided R0 resection is achieved with margin-negative status of the remnant liver, bile duct, proximal hepatic artery, and portal vein. End-to-end anastomosis of the portal trunk to the left portal branch is the conventional portal reconstruction in cases of right extended hepatectomy requiring resection of the portal vein bifurcation. This mandatory reconstruction may be challenging due to (1) vessel incongruence, (2) fragility of the left portal branch wall, and more importantly, and (3) the divergent orientation of the two vessels exposing to vascular twisting/kinking. We report here the first two cases of porto-Rex shunt, between the portal vein trunk and the left portal vein in the umbilical fissure during right extended hepatectomy for advanced extrahepatic biliary cancer: one following failed conventional portal reconstruction and one to achieve macroscopically complete resection.
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ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-018-04895-8