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Usefulness of a recanalized umbilical vein for vascular reconstruction in pediatric hepatic surgery

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Abstract

Purpose

Pediatric surgeons currently engage in various abdominal vascular surgeries, which sometimes require vascular conduits or grafts. Herein, we report our experience with patients undergoing vascular reconstruction using a recanalized umbilical vein (rUV) and their long-term outcome.

Method

Five patients with extrahepatic portal vein obstruction (EHPVO) underwent mesenterico-/porto-left portal vein (PV) bypass surgery using a short rUV conduit with an interposition vein graft. A sixth neonate with a huge hepatic tumor underwent PV reconstruction with anastomosis of rUV to the proximal PV stump following right hepatectomy with partial PV resection. A seventh patient underwent living donor liver transplantation for recurrent hepatoblastoma. The hepatic inferior vena cava (IVC) was resected because of tumor involvement and reconstructed by transposition of the infrahepatic IVC and interposition of rUV obtained from the donor liver graft.

Results

Sufficient flow through rUV was achieved and maintained in all patients without any complications during follow-up (0.7–6.9 years). Esophageal varices, splenomegaly, and other laboratory test abnormalities because of portal hypertension disappeared after surgery in patients with EHPVO.

Conclusion

Our experience confirmed the usefulness and long-term patency of rUV as an entry to the intrahepatic PV and as a free vascular graft to reconstruct PV or IVC.

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Acknowledgments

A part of this study was presented at the 16th Congress of the European Paediatric Surgeons’ Association, Ljubljana, Slovenia, June 17–20, 2015. We are grateful to Toshimitsu Yanagi MD, Hideaki Ueda MD (Department of Cardiology), and Kumiko Nozawa MD, PhD (Department of Radiology, Kanagawa Children’s Medical Center) for great assistance in diagnostic and interventional radiology. The authors would like to thank Enago (www.enago.jp) for the English language review.

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Correspondence to Masato Shinkai.

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Shinkai, M., Mochizuki, K., Kitagawa, N. et al. Usefulness of a recanalized umbilical vein for vascular reconstruction in pediatric hepatic surgery. Pediatr Surg Int 32, 553–558 (2016). https://doi.org/10.1007/s00383-016-3893-2

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  • DOI: https://doi.org/10.1007/s00383-016-3893-2

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