Portal Venoplasty in the Field of Hepatobiliary Pancreatic Surgery and Liver Transplantation

Editorial

Austin J Surg. 2014;1(1): 1005.

Portal Venoplasty in the Field of Hepatobiliary Pancreatic Surgery and Liver Transplantation

Tsukasa Nakamura*a,b, Toshimasa Nakaoa, Shumpei Haradaa, Takashi Ito, Hidetaka Ushigome ,Norio Yoshimuraa

aDepartment of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Japan

bDepartment of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Japan

*Corresponding author: Tsukasa Nakamura, Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan

Received: February 05, 2014; Accepted: February 10, 2014; Published: February 14, 2014

Recent advances in portalvenoplasty enable us to accomplish complex pancreaticoduodenectomy including liver dissection (PD), and liver transplantation (LT). Technical issues regarding PD and LT surgery is essentially the same. In the field of PD, cases where a malignant tumour directly invades the portal vein, it will require a venous resection combined with reconstruction in order to obtain complete tumour clearance (R0).

In a case where the tumour does not involve the entire circumference, a wedge resection can simply be done with a longitudinal vascular anastomosis. When venoplasty with primary repair is difficult, a size–matched patch is required. The great saphenous vein (GSV) is most widely used as a venous patch graft. However, venoplasty of a wedge resection is often complicated and sometimes leads to venous torsion, stenosis and increased risk of thrombosis. In this case, it is better to perform the complete resection of the tumour–involved PV and primary end–to–end anastomosis rather than undertaking a complicated wedge resection, when semitotal circumference tumour involvement is confirmed. Generally, performing the extended Kocher manoeuvre enables the PV to be close enough to be an astomosed, provided the gap between the portal veins is less than 5 cm in length. However, in cases where the gap is longer than required for a venous graft it is mentioned below.

When portal flow clamping takes more than 30 minutes, the port–caval bypass technique is used, by means of the Anthron antithrombogenic catheter [1], it is recommended to prevent congestion in the intestine. This catheter is most commonly used to bypass the superior mesenteric vein (SMV) to the femoral vein in order to avoid portal congestion, and allows ample time for resection and reconstruction. Generally, these port venoplasty techniques are well established and surgical morbidity is minimized [2].

In the field of LT, there are some differences between a donation after brain death (DBD) LT, donation after cardiac death (DCD) LT and live donor LT in terms of portal venoplasty. Generally, the portal vein of the graft in the case of a live donor is inevitably shorter in length compared to that of a cadaveric donor. Furthermore, anatomical variation and a size mismatch of the PV are sometimes encountered in a live donor LT. Nevertheless, the aim for obtaining enough portal flow is fundamentally the same regardless of LT types. Therefore, although careful attention should be paid to a live donor LT, it can be argued that a wide variety of techniques in portal venoplasty, which also can be applied in PD, are required for surgeons who deal with a LT. In this paper, abnormal cases, where normal portal venoplasty cannot be achieved primarily due to PVthrombosis (PVT), are argued.

The incidence of what we encounter with PVT in cases of a LT is quite varied depending on the status of patients. A variety of methods can be used to obtain normal portal flow. It seems to be a good surgical strategy to follow the order as mentioned below.

Citation: Nakamura T, Nakao T, Harada S, Yoshimura N. Portal Venoplasty in the Field of Hepatobiliary Pancreatic Surgery and Liver Transplantation. Austin J Surg. 2014;1(1): 1005. ISSN: 2381-9030.