New strategy using laparoscopic hepatectomy for an intrahepatic portal-hepatic venous shunt with hyperammonemia (with video).

Intrahepatic portal and hepatic venous shunts have been reported in children (Takama et al. Surg Case Rep 2020;6(1):73) but are very rare in adults (Papamichail et al. Hepatobiliary Pancreat Dis Int 2016;15(3):329-333). Treatment is indicated in cases of portal hypertension or hyperammonemia. We evaluated and reported the usefulness, safety, and effectiveness of laparoscopic liver resection for this case. After performing intraoperative ultrasonography, the hilar plate was manipulated to identify the target Glissonean branch of segment 5 (G5). Bulldog forceps were then used for test clamping, which was identified by negative staining, Segment 5 was dissected and hepatic parenchymal resection was performed. The hepatic veins running within the ischemic area were dissected, and hepatic parenchymal resection, including intrahepatic portal and hepatic venous shunts, was performed. The operation time was 257 min, and she was discharged on the 8th postoperative day, with no complications. Serum ammonia levels decreased rapidly postoperatively. Laparoscopic liver resection may be effective for intrahepatic portal and hepatic venous shunts.