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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
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

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.

Conclusion

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.

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Acknowledgments

We would like to acknowledge Dr. Krishna Juluru and Ms. Adrienne B. Coya from the Imaging Data Evaluation & Analysis Laboratory, Weill Cornell Department of Radiology for their assistance in image requisition and optimization.

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No disclosures and no grant support.

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Authors and Affiliations

  1. Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA

    Ser Yee Lee, Daniel Cherqui & Michael D. Kluger

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  1. Ser Yee Lee
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  2. Daniel Cherqui
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  3. Michael D. Kluger
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Correspondence to Michael D. Kluger.

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Lee, S.Y., Cherqui, D. & Kluger, M.D. Extended Right Hepatectomy in a Liver with a Non-bifurcating Portal Vein: the Hanging Maneuver Protects the Portal System in the Presence of Anomalies. J Gastrointest Surg 17, 1494–1499 (2013). https://doi.org/10.1007/s11605-013-2161-1

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  • DOI: https://doi.org/10.1007/s11605-013-2161-1

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