Beneficial use of the round ligament as a patch graft for vena cava reconstruction.
OBJECTIVE
The availability of an appropriate vascular graft is a significant concern in an extensive hepatic resection with part of the vena cava.


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.
Ikegami
Toru
T
Department of Surgery, The University of Tokushima, Tokushima, 770-8503, Japan.
Shimada
Mitsuo
M
Imura
Satoru
S
Morine
Yuji
Y
Kanemura
Hirofumi
H
Mori
Hiroki
H
Arakawa
Yusuke
Y
Hanaoka
Jun
J
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D012404:Round Ligament of Uterus / Q000637:transplantation*; D016042:Transplantation, Heterotopic; D014682:Vena Cava, Inferior / Q000601:surgery*