Journal of Gastrointestinal Surgery

, Volume 17, Issue 8, pp 1494–1499

Extended Right Hepatectomy in a Liver with a Non-bifurcating Portal Vein: the Hanging Maneuver Protects the Portal System in the Presence of Anomalies

Case Report

DOI: 10.1007/s11605-013-2161-1

Cite this article as:
Lee, S.Y., Cherqui, D. & Kluger, M.D. J Gastrointest Surg (2013) 17: 1494. doi:10.1007/s11605-013-2161-1



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.

Case Report

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.


Surgical technique Hepatectomy Hanging maneuver Portal vein anatomy 

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Ser Yee Lee
    • 1
  • Daniel Cherqui
    • 1
  • Michael D. Kluger
    • 1
  1. 1.Section of Hepatobiliary Surgery and Liver Transplantation, Department of SurgeryNew York-Presbyterian Hospital/Weill Cornell Medical CenterNew YorkUSA

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