Right hepatectomy: mishaps of extra-hepatic portal vein division

En-bloc clamping of the hepatic pedicle is commonly performed during liver resection in order to reduce bleeding during parenchymal transection. Selective vascular clamping of the ipsilateral portal vein branch and artery is considered preferable to avoid ischemia-reperfusion injury to the future liver remnant and there has as yet been no reports of serious morbidity related to this technique. Herein we report three adverse incidents associated with attempts at extrahepatic control and division of the right portal vein during hepatectomy. Although extrahepatic control of the right portal vein is simple in a majority of patients caution is advised in the presence of anatomical variations of the right portal vein, liver dysmorphia, preoperative portal vein embolization and during the learning curve of laparoscopic liver resection. A Pringle maneuver may be preferable to hemihepatic inflow occlusion for repeat hepatectomies.