Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3844_Библиотеки_им_академика_М_И_Перельмана

Almost all the venous reconstructions are done in the piggyback fashion, and consequently, the preservation of IVC is mandatory. Ahead of the plasty of hepatic IVC, the preservation of the native hepatic IVC is a key factor during the explant of the native liver in any type of venous reconstruction. Since a partial graft procured from a live donor has only the orifice of corresponding hepatic veins and is lacking IVC, the recipient hepatic IVC including the confluence of three hepatic veins must be preserved to the possible extent. In addition, the stumps of hepatic veins should be prepared to be widely opened for outflow reconstruction (Fig. 12.1).

Relatively large short hepatic veins in right liver graft, so-called IRHV, and middle right hepatic vein (MRHV) and a caudate vein (draining Spiegel lobe) in left liver with Spiegel lobe should be reconstructed to expect the maximal graft function and regeneration. Of course, it is possible to anastomose these veins of the graft directly to the recipient IVC in an end-to-side fashion with a side clamping of IVC [5, 17]. In such instances, recipient IVC is incised which is corresponding to these veins of the graft. Direct anastomosis between the short hepatic vein and the recipient IVC is sometimes technically demanding. Because determining the optimal anastomotic site and direction is difficult and requires time, this may increase the warm ischemic time. To overcome these problems, we have recommended the reconstruction of these veins on the bench surgery, utilizing the cryopreserved homologous veins. In right liver graft with IRHV or MRHV, if the IVC graft is available, IRHV and MRHV can be reconstructed at the bench, which is called the double IVC method [10, 11] (Fig. 12.5). If the IVC graft is not available, but a thinner vein graft such as the femoral vein is available, similar reconstruction is possible [18] (Fig. 12.6). We must note that, in this case, extensive dissection of the IVC around the hepatic vein branches, including the phrenic veins, is unnecessary.

In left liver graft, when a short hepatic vein and LHV + MHV are located close to each other, simple venoplasty at the bench is possible. Another option includes venoplasty using vein grafts at the bench. On the graft side, a wide venous orifice with a long cuff is formed by gathering the left, middle, and short hepatic veins using a conduit vein graft and patch vein grafts [ tomosed to wide-opened recipient IVC.