title: Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy.
abstract: Hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer; however, one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver, which may cause postoperative liver failure. To induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver, procedures to occlude the portal vein have been conventionally used prior to major hepatectomy. We report a case of a 50-year-old woman in whom two-stage hepatectomy was performed in combination with intraoperative ligation of the portal vein and the bile duct of the right hepatic lobe. This procedure was designed to promote the atrophic effect on the right hepatic lobe more effectively than the conventional technique, and to the best of our knowledge, it was used for the first time in the present case. Despite successful induction of liver volume shift as well as the following procedure, the patient died of subsequent liver failure after developing recurrent tumors. We discuss the first case in which simultaneous ligation of the portal vein and the biliary system was successfully applied as part of the first step of two-stage hepatectomy.
authors.affiliation: Department of Surgery, Meiwa Hospital 4-31 Agenaruo-cho, Nisinomiya, 663-8186 Hyogo, Japan. hiroya0001@mac.com
authors.forename: Hiroya
authors.initials: H
authors.lastname: Iida
authors.forename: Chiaki
authors.initials: C
authors.lastname: Yasui
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Aihara
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ikuta
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshie
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamanaka
mesh_terms: D001652:Bile Ducts / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation / Q000379:methods; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*