Abstract
Resection offers the only chance of long-term survival or cure for perihilar cancer, provided R0 resection is achieved with margin-negative status of the remnant liver, bile duct, proximal hepatic artery, and portal vein. End-to-end anastomosis of the portal trunk to the left portal branch is the conventional portal reconstruction in cases of right extended hepatectomy requiring resection of the portal vein bifurcation. This mandatory reconstruction may be challenging due to (1) vessel incongruence, (2) fragility of the left portal branch wall, and more importantly, and (3) the divergent orientation of the two vessels exposing to vascular twisting/kinking. We report here the first two cases of porto-Rex shunt, between the portal vein trunk and the left portal vein in the umbilical fissure during right extended hepatectomy for advanced extrahepatic biliary cancer: one following failed conventional portal reconstruction and one to achieve macroscopically complete resection.
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References
Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y (2013) Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 258(1):129–140
Chen W, Ke K, Chen YL (2014) Combined portal vein resection in the treatment of hilar cholangiocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol 40(5):489–495
de Ville de Goyet J, Gibbs P, Clapuyt P, Reding R, Sokal EM, Otte JB (1996) Original extrahilar approach for hepatic portal revascularization and relief of extrahepatic portal hypertension related to later portal vein thrombosis after pediatric liver transplantation. Long term results. Transplantation 62(1):71–75
de Ville de Goyet J, Alberti D, Clapuyt P, Falchetti D, Rigamonti V, Bax NM, Otte JB, Sokal EM (1998) Direct bypassing of extrahepatic portal venous obstruction in children: a new technique for combined hepatic portal revascularization and treatment of extrahepatic portal hypertension. J Pediatr Surg 33(4):597–601
di Francesco F, Grimaldi C, de Ville de Goyet J (2014) Meso-Rex bypass, a procedure to cure prehepatic portal hypertension: the insight and the inside. J Am Coll Surg 218(2):e23–e36
Reichman TW, Anthony T, Testa G (2011) Treatment of extrahepatic portal hypertension following a Whipple procedure with a Rex shunt: report of a case. Surg Today 41(2):292–296
Yamamoto S, Sato Y, Oya H, Nakatsuka H, Watanabe T, Takizawa K, Hatakeyama K (2009) Splenic-intrahepatic left portal shunt in an adult patient with extrahepatic portal vein obstruction without recurrence after pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg 16(1):86–89
Dardik H, Wengerter K, Qin F et al (2002) Comparative decades of experience with glutaraldehyde-tanned human umbilical cord vein graft for lower limb revascularization: an analysis of 1275 cases. J Vasc Surg 35:64–71
Facciuto ME, Rodriguez-Davalos MI, Singh MK et al (2009) Recanalized umbilical vein conduit for meso-Rex bypass in extrahepatic portal vein obstruction. Surgery 145:406–410
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Lahat, E., Jaber, A., Salloum, C. et al. Porto-Rex Shunt for Left Portal Vein Reconstruction During Right Extended Hepatectomy for Advanced Extrahepatic Biliary Cancer. World J Surg 43, 1117–1120 (2019). https://doi.org/10.1007/s00268-018-04895-8
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DOI: https://doi.org/10.1007/s00268-018-04895-8