title: Unification venoplasty to cope with recipient portal vein anomaly during living donor liver transplantation.
abstract: OBJECTIVE
  To cope with recipient portal vein (PV) anomalies, such as early branching of the right posterior section (RPS), during living donor liver transplantation (LDLT) surgery, we performed a simulation study to standardize the surgical technique for unification portal venoplasty.
  
  
  METHODS
  This study included an observational analysis of conventional methods utilizing RPS PV, simulation-based design of a new surgical technique, and clinical application of this new technique.
  
  
  RESULTS
  In a case encountering RPS PV, a mild anastomotic PV stenosis was persistent over 6 months postsurgery, indicating the need for technical refinement. After computational simulation analysis, we found that simple suturing of the PV branch patch automatically resulted in a funnel-shaped elongation. A prospective recipient study (n = 30) indicated that usual PV reconstruction via the PV bifurcation method is feasible in the absence of unusual donor or recipient PV anomaly. Retrospective living donor PV anatomy analysis (n = 20) revealed that 20-mm-long limbs of the first-order PV branches are necessary to make a 10- to l5-mm-long funneled PV stump. This technique of unification venoplasty for an anomalous recipient PV was applied to an adult patient undergoing LDLT with a right liver graft, for which it was shown to be technically feasible and effective.
  
  
  CONCLUSIONS
  A simplified unification venoplasty technique was developed to cope with a recipient PV anomaly in adult LDLT.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Kang
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: C-S
authors.initials: CS
authors.lastname: Ahn
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: T-Y
authors.initials: TY
authors.lastname: Ha
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: J-M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: Y-H
authors.initials: YH
authors.lastname: Park
authors.forename: H-W
authors.initials: HW
authors.lastname: Park
authors.forename: B-H
authors.initials: BH
authors.lastname: Jung
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D011169:Portal Vein / Q000002:abnormalities* / Q000601:surgery