Transumbilical portal venous catheterization: a useful adjunct in left lobe living donor liver transplantation

Applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery-a review of their utility and efficacy

BACKGROUND AND PURPOSE

Despite their ubiquitous presence, easy availability and diverse possibilities, falciform ligament and hepatic round ligament have been used less frequently than their potential dictates. This article aims to comprehensively review the applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery and assess their utility and efficacy.

METHODS

Medical literature/indexing databases were searched, using internet search engines, for pertinent articles and analysed.

RESULTS

The studied flap and graft have found utility predominantly in the management of diaphragmatic hernias, gastro-oesophageal reflux disease, peptic perforations, biliary reconstruction, venous reconstruction, post-operative pancreatic fistula, post-pancreatectomy haemorrhage, hepatic cyst cavity obliteration, liver bleed, sternal dehiscence, splenectomy, reinforcement of aortic stump, feeding access, diagnostic/therapeutic access into portal system, composite tissue allo-transplant and ventriculo-peritoneal shunting where they have exhibited the desired efficacy.

CONCLUSIONS

Hepatic round ligament/falciform ligament flap and graft are versatile and have multifarious applications in abdominal surgery with some novel and unique uses in hepatopancreaticobiliary surgery including liver transplantation. Their evident efficacy needs wider adoption to realise their true potential.

Transhepatic-intrahepatic branches of the portal vein catheterization for ex vivo liver resection and autotransplantation: Two case reports of novel approach to perfuse the liver

RATIONALE

There has been increased use of ex vivo liver resection and autotransplantation (ERAT) for treatment of end-stage hepatic alveolar echinococcosis (HAE). Rapid perfusion of the autograft in bench resection is always required to reduce the warm ischemia time (WIT) and to protect the function of the remnant liver. Nevertheless, the severe invasion of the portal hepatis sometimes makes it impossible to find a usable inflow rapidly and the process of perfusion could be delayed.

PATIENT CONCERNS

Two patients diagnosed with end-stage HAE combined with severe portal hepatis invasion were selected to undergo ERAT at our center.

DIAGNOSIS

Besides the large HAE lesions, the CT imaging of patient 1 showed that part of the intra- and extrahepatic portal vein (PV) had disappeared. Patient 2 had severe invasion of both of the right and left branches of the PV.

INTERVENTIONS

We introduced a new approach for perfusing the liver in ERAT using transhepatic-intrahepatic branches of the PV catheterization. Afterward, ERAT was successfully performed.

OUTCOMES

For patient 1, the WIT was 2 minutes and the cold ischemia time (CIT) was 296 minutes. For patient 2, the WIT was 2 minutes and the CIT was 374 minutes. Patient 1 suffered stenosis of the common bile duct on postoperative day 14, and patient 2 recovered uneventfully. Both of the 2 patients were discharged from the hospital with normal laboratory values on postoperative day 31 and 15, respectively. The laboratory values for both patients at recent follow-up were normal.

LESSONS

Transhepatic-intrahepatic branches of the PV catheterization is useful for decreasing WIT and facilitating the management of ERAT. It is a useful technical variant that could be used in ERAT for treating patients with severe portal hepatis invasion.