A new technique for reconstruction of the middle hepatic vein without graft interposition: "the digging technique"

Ill-located liver metastases close to the cavo-hepatic confluence often require resection and reconstruction of hepatic veins. However, most of the current techniques for reconstruction of the hepatic veins require graft interposition or complex venoplasty. The present case report describes a new surgical procedure which allows reconstructing the middle hepatic vein (MHV) by direct end-to-end anastomosis after a right hepatectomy for colorectal liver metastases invading the right and middle hepatic veins. This technique is called the "digging technique", in which an additional atypical resection of a part of segment 4a "digging" around the distal end of the MHV in order to further mobilize the liver and to achieve, with an upward lifting of the remnant liver, a tension-free end-to-end reconstruction of the MHV. The immediate postoperative course was uneventful. After 6 months of follow-up the patient was well and the MHV was patent. In selected patients with liver metastases close to the MHV-inferior vena cava confluence, requiring a right hepatectomy, the "digging technique" allows a safe direct end-to-end anastomosis avoiding graft interposition.