Abstract:
An 18-year-old male living donor for his father with end-stage liver cirrhosis due to
hepatitis B underwent an extended right lobe donor hepatectomy. The middle hepatic vein
was visualised on the cut surface of the graft and dissected up to the confluence of the
middle and left hepatic veins. After vascular clamping, right and middle hepatic veins were
cut to removed the graft. While starting the stump closure, the clamp over the middle
hepatic vein slipped and the vein stump sutured quickly under suboptimal exposure. Soon
after this closure, the remnant liver showed increasing congestion. Intraoperative Doppler
ultrasound revealed obstruction of venous outflow at the remnant left liver due to stenosis
in the left hepatic vein. Under total hepatic vascular occlusion, the sutures were removed
from the narrowed left hepatic vein. A 2 2 cm peritoneal patch from the subcostal area
that was prepared to close the defect was sutured to the edges of the left hepatic vein
defect. Venous congestion of the liver disappeared when the clamps were removed.
Intraoperative Doppler ultrasound confirmed normal hepatic venous flow. The postoperative
course of the donor was uneventful. There was no clinical, biochemical, or
radiological problems at 47 months of follow-up. An autogenous peritoneal patch may be
a good option to repair vascular defects, which are not suitable for primary sutures, due to
easy accessibility and size adjustment, cost effectiveness, as well as relatively low risk of
infection and thrombosis. Close dissection of the left hepatic vein during parenchymal
transection over the middle hepatic vein can result in narrowing, particularly at the
bifurcation of the middle/left hepatic veins that can cause congestion in the remnant liver.
When we include the middle hepatic vein with the right graft, we now believe that
dissection away from the left hepatic vein seems much more secure for donors.
