Hepatic Artery Reconstruction with a Continuous Suture Method for Hepato-Biliary-Pancreatic Surgery

In some cases, hepato-biliary-pancreatic (HBP) surgery requires hepatic artery resection and hepatic artery reconstruction (HAR) for histologically curative resection. We describe our surgical HAR technique, which involves continuous suturing, and we report the results of a study of the surgical outcomes.

Between 2000 and 2014, 380 patients underwent radical surgery for advanced HBP malignancies (118 bile duct cancers, 189 pancreatic head cancers, and 73 gallbladder cancers), 24 of whom (6.3 %) underwent HAR (for complete cure of 16 bile duct cancers, 5 pancreatic cancers, and 3 gallbladder cancers). The 24 surgical procedures included 8 hepato-pancreatoduodenectomies, 10 hepatectomies, and 6 pancreatoduodenectomies. The ends of the 2 arteries were spatulated, and the reconstruction was performed with a continuous 7-0 polypropylene suture under loupe magnification.

Eighteen right hepatic arteries, 4 left hepatic arteries, and 2 proper hepatic arteries were resected and reconstructed. Median HAR time was 18 min (range 9-31 min). End-to-end anastomosis was performed in 7 patients, and heterogeneous reconstruction was performed in 17 patients (with 9 colic arteries, 4 gastroduodenal arteries, and 4 others). Doppler ultrasonography performed upon vessel reconstruction depicted pulsatile flow within the intrahepatic arteries in all cases, and patency of the reconstructed vessel was confirmed postoperatively by contrast-enhanced CT in 19 patients (82.6 %). Morbidity occurred in 10 patients (42 %), including 4 HAR-related complications: 3 bile leakages and 1 hepatic abscess.

Our HAR method can be performed safely and easily by general surgeons. It may be a time-saving procedure that yields acceptable patency and morbidity rates.