Journal of hepato-biliary-pancreatic surgery · 2008
Beneficial use of the round ligament as a patch graft for vena cava reconstruction.
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Ikegami Toru, Shimada Mitsuo, Imura Satoru, Morine Yuji, Kanemura Hirofumi, Mori Hiroki, Arakawa Yusuke, Hanaoka Jun
Аннотация
BACKGROUND/PURPOSE: The availability of an appropriate vascular graft is a significant concern in an extensive hepatic resection with part of the vena cava.
METHODS/RESULTS: The patient had multinodular hepatocellular carcinoma, occupying the whole posterior segment with a tumor thrombus bulging inside the vena cava. At laparotomy, a segment of the round ligament was procured for use as a patch graft. After the mobilization of the right-side liver without taking down the short hepatic veins, parenchymal resection was completed with the use of a hanging maneuver. The hepatic vena cava was semitotally side-clamped, followed by resection of the caval wall with the tumor thrombus, resulting in an en-bloc resection. The procured round ligament was opened, trimmed, and sutured to the vena cava as a patch graft, followed by smooth reperfusion.
CONCLUSIONS: The use of an opened round ligament as a venous patch graft is an easy and feasible technique in patch reconstruction of the vena cava.
METHODS/RESULTS: The patient had multinodular hepatocellular carcinoma, occupying the whole posterior segment with a tumor thrombus bulging inside the vena cava. At laparotomy, a segment of the round ligament was procured for use as a patch graft. After the mobilization of the right-side liver without taking down the short hepatic veins, parenchymal resection was completed with the use of a hanging maneuver. The hepatic vena cava was semitotally side-clamped, followed by resection of the caval wall with the tumor thrombus, resulting in an en-bloc resection. The procured round ligament was opened, trimmed, and sutured to the vena cava as a patch graft, followed by smooth reperfusion.
CONCLUSIONS: The use of an opened round ligament as a venous patch graft is an easy and feasible technique in patch reconstruction of the vena cava.