Extended Right Hepatectomy in a Liver with a Non-bifurcating Portal Vein: the Hanging Maneuver Protects the Portal System in the Presence of Anomalies
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- Lee, S.Y., Cherqui, D. & Kluger, M.D. J Gastrointest Surg (2013) 17: 1494. doi:10.1007/s11605-013-2161-1
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Variations in portal vein anatomy occur in 20–35 % of individuals. A non-bifurcating portal vein (PV) was suspected on preoperative imaging in a patient with a large right lobe hepatocellular carcinoma. The single PV curved within the liver parenchyma from right to left supplying second-order branches along its course.
Utilizing the hanging maneuver, an extended right hemihepatectomy was safely performed. This approach allowed for preservation of the main PV and its left-sided branches while easily identifying the second-order right branches for ligation.
Knowledge of portal vein variations and identification preoperatively by cross-sectional imaging are critical. The hanging maneuver aids in the preservation of the main portal vein and its left-sided branches during right hemihepatectomy in the presence of portal vein anomalies, and this technique can be used to improve safety in hepatobiliary surgery.