Significance of hepatic vein reconstruction in hepatectomy

To preserve remnant liver function, hepatectomy combined with hepatic vein (HV) reconstruction was performed in resection of the tumor located at the confluence of the HV and inferior vena cava.

Eight patients underwent HV reconstruction: the right HV in three, the middle HV in four, and the left HV in one. An external iliac vein graft was used in two patients, a superficial femoral vein graft in three, and a long saphenous vein graft in one. In one patient a patch graft was applied to the right HV; another patient underwent end-to-end anastomosis of the right HV without grafting.

There were no operative deaths and liver function was adequate throughout the postoperative period. Complications included two cases of minor biliary fistula. The middle HV with a saphenous graft and the left HV with an external iliac graft became occluded because of size mismatch at the anastomosis. Six veins were patent at 1 month and three were still patent after 30 months.

To prevent graft occlusion, it is important to select an autologous vein of optimal size and avoid inflammation of the liver stump. HV reconstruction appears to be a new surgical option for patients undergoing hepatectomy.