Right hepatectomy in absence of the left portal vein using the porto-rex shunt procedure
Author:
Lang Sven A.12, Bednarsch Jan12, Schmitz Sophia M.12, Helmedag Marius J.1, Amygdalos Iakovos1, Heise Daniel12, Dewulf Maxime13, Ulmer Tom F.12, Neumann Ulf P.132
Affiliation:
1. Department of Surgery and Transplantation , 39081 University Hospital RWTH Aachen , Aachen , Germany 2. Department of General, Visceral and Transplant Surgery , 39081 University Hospital Essen , Essen , Germany 3. Department of Surgery , 39081 Maastricht University Medical Centre (MUMC) , Maastricht , Netherlands
Abstract
Abstract
Objectives
Exact knowledge of the portal vein (PV) anatomy is essential for any hepatobiliary procedure. Absence of the portal bifurcation with the complete blood flow to the left lobe coming from the right portal vein (RPV) is an extremely rare anatomical variation.
Case presentation
In this situation, a solitary metachronous colorectal liver metastasis with suspected infiltration of the RPV and the right bile duct was detected in a 51-year-old male patient. Neither percutaneous ablation nor stereotactic radiotherapy were considered indicated due to the close proximity to the central structures. Hence, a surgical two-step procedure was scheduled. First, a porto-rex shunt with an 8 mm PTFE graft to maintain the portal blood flow to the left lobe was performed. In addition, the RPV was ligated during the same procedure. After recovery, the procedure was completed with a right hepatectomy. The final pathological report confirmed invasion of the right bile duct and the RPV and resection margins were tumor-free.
Conclusion
This case shows that careful preoperative assessment of vascular anatomy is critical. The use of the porto-rex shunt allowed a potentially curative resection in an otherwise irresectable situation.
Publisher
Walter de Gruyter GmbH
Reference10 articles.
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