title: Wedge resection of the portal bifurcation concomitant with left hepatectomy plus biliary reconstruction for hepatobiliary cancer.
abstract: OBJECTIVE
  We report our experience performing wedge resection of the portal bifurcation and transverse suture closure in patients undergoing left hepatectomy and caudate lobectomy plus biliary reconstruction for hepatobiliary cancer.
  
  
  METHODS
  The procedure was performed in three patients with hilar or intrahepatic cholangiocarcinoma. After confirming that tumor invasion of the portal bifurcation was not circumferential, the portal trunk and the right posterior and right anterior portal branches were isolated and clamped. Wedge resection of the portal bifurcation was performed, taking care to secure a clear surgical margin. The edges of the portal vein were approximated, using guy-sutures in the dorsal and ventral edges and a temporary central guy-suture, and portal reconstruction was carried out using a continuous transverse suture. After unclamping, good portal flow was confirmed by color Doppler ultrasonography.
  
  
  RESULTS
  The procedure was completed successfully in all three patients; the average time of portal vein occlusion was 15 min. Two patients had postoperative complications: bile leakage and wound infection, but no patient developed postoperative hepatic failure or died. The three patients are alive without recurrence at 2, 11, and 22 months after the operation.
  
  
  CONCLUSIONS
  Wedge resection of the portal bifurcation is easier and simpler than using a venous patch or performing segmental resection.
authors.affiliation: Surgical Oncology, Cancer Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Katoh
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Ambo
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: You
authors.initials: Y
authors.lastname: Kawarada
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Kaji
authors.forename: Setsuyuki
authors.initials: S
authors.lastname: Ohtake
authors.forename: Shunichi
authors.initials: S
authors.lastname: Okushiba
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Morikawa
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications; D013536:Suture Techniques