title: Resection and reconstruction of retrohepatic vena cava without venous graft during major hepatectomies.
abstract: BACKGROUND
  Progress in liver surgery has enabled hepatectomy with concomitant venous resection for liver malignancies involving the inferior vena cava (IVC). The authors describe an alternative technique for IVC reconstruction without the need of graft.
  
  
  METHODS
  Parenchymal transection is performed from anterior surface of the liver down to the anterior or left lateral surface of the IVC using combination of two techniques reported elsewhere. IVC is clamped above and below the tumor and the liver in continuity with an invaded segment of IVC is removed en bloc. A transverse anastomosis of IVC is performed starting with running suture on the posterior wall followed by the anterior wall.
  
  
  RESULTS
  This approach has been successfully employed in eight consecutive patients with IVC involvement. The procedures performed were 5 right hepatectomies, 1 right posterior sectionectomy, 1 right trisectionectomy, and 1 left trisectionectomy. Two patients needed total vascular exclusion (TVE) for 11 and 10 min, respectively. Blood transfusion was necessary in three patients. Pathologic surgical margins were free in all cases. No postoperative mortality was observed.
  
  
  CONCLUSIONS
  This technique of IVC reconstruction precludes the use of graft and minimizes the use of TVE decreasing ischemic damage to the remnant liver.
authors.affiliation: Department of Gastroenterology, University of São Paulo, São Paulo, Brazil. dr@drmarcel.com.br
authors.forename: Marcel Autran C
authors.initials: MA
authors.lastname: Machado
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.forename: Telesforo
authors.initials: T
authors.lastname: Bacchella
authors.forename: Marcel C C
authors.initials: MC
authors.lastname: Machado
mesh_terms: D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*