[Excision and reconstruction of anomalous portal venous branching in adult-to-adult right lobe living donor liver transplantation].
OBJECTIVE
To discuss the techniques for excision and reconstruction of anomalous portal venous branches (APVB) in adult-to-adult right lobe living donor liver transplantation (A-A RL LDLT).


METHODS
From February 2002 to April 2007, 70 cases of A-A RL LDLT were performed. Preoperative three-dimensional computed tomography of the donor revealed the configurations of hepatic artery, portal vein and hepatic vein. Nine donors had anomalous portal venous branching (APVB). The APVB were type II (trifurcation) in 7 cases and type III in two. Except the excision of APVB with a common opening by a narrow bridge of main portal vein tissue in one type II donor, all the right APVB were transected on the principal of donor priority: right APVB being excised approximately 2-3 mm from the confluence while leaving the donor's portal vein intact. In type II APVB, the donor portal venous branches were transected with separate two openings and reconstructed as double anastomoses in 4 cases, with separate two openings joined as a common orifice at the back table and reconstructed as single anastomoses in 2 cases, and with one common opening with narrow-bridge of tissue and reconstructed as single anastomoses in 1 case. In type III APVB, the APVB were transected with separate two openings and were reconstructed by double anastomoses in 1 case and by a new technique named U-shaped vein graft interposition in the another one.


RESULTS
There were no vascular complications such as portal vein stricture or thrombosis, hepatic artery stricture or thrombosis and hepatic vein outflow stricture in all 9 recipients transplanted with grafts with APVB. Only the type II APVB donor undergoing a excision of APVB with a common opening by a narrow bridge of main portal vein tissue developed portal vein thrombosis on the third postoperative day and underwent thrombectomy followed by repair with vein patch plasty. The velocity of blood flow in the U-graft was normal.


CONCLUSIONS
It is feasible and safe of APVB excision on the principal of donor priority and reconstruction including double anastomoses and the novel U-graft interposition in A-A RL LDLT, and has a good outcome without increasing the management difficulty.
Xu
Ming-Qing
MQ
Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu 610041, China.
Yan
Lü-Nan
LN
Li
Bo
B
Zeng
Yong
Y
Wen
Tian-Fu
TF
Zhao
Ji-Chun
JC
Wang
Wen-Tao
WT
Yang
Jia-Yin
JY
Ma
Yu-Kui
YK
Cheng
Zhe-Yu
ZY
Zhang
Zhong-Wei
ZW
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D011169:Portal Vein / Q000002:abnormalities / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome