PubMed · 14002928
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E YVERGNEAUX, A BREMER. 1963. [Hapatic surgery].. https://pubmed.ncbi.nlm.nih.gov/14002928/
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Segment III bypass can achieve excellent palliation in jaundiced patients with unresectable malignancy of the hepatic duct confluence. However, the long-term benefits are often offset by early morbidity and mortality associated with surgery. Bile leakage is a common postoperative complication. Several approaches to the segment III duct have been described. The "round ligament approach" identifies the segment III duct by following the round ligament into the recessus of Rex, in the umbilical fissure. It is the approach adopted by most units, including our own. The liver is often split to a depth of 5 to 6 cm to expose the duct. Fashioning an intrahepatic cholangiojejunostomy within the recess of the umbilical fissure can be technically difficult due to lack of space. We describe a modification of the round ligament approach, creating a long and tension-free cholangiojejunostomy, which we believe reduces the incidence of postoperative bile leakage.
OBJECTIVE: To evaluate anatomic variations of the biliary tree as applied to living donor liver transplantation. SUMMARY BACKGROUND DATA: Anatomic variability is the rule rather than the exception in liver surgery. However, few studies have focused on the anatomic variations of the biliary tree in living donor liver transplantation in relation to biliary reconstruction. METHODS: From November 1992 to June 2002, 165 patients underwent major hepatectomy with extrahepatic bile duct resection; right-sided hepatectomy in 110 patients and left-sided hepatectomy in 55. Confluence patterns of the intrahepatic bile ducts at the hepatic hilum in the surgical specimens were studied. RESULTS: Confluence patterns of the right intrahepatic bile ducts were classified into 7 types. The right hepatic duct was absent in 4 of the 7 types and in 29 (26%) of the 110 livers. Confluence patterns of the left intrahepatic bile ducts were classified into 4 types. The left hepatic duct was absent in 1 of the 4 types and in 1 (2%) of the 55 livers. CONCLUSIONS: In harvesting the right liver from a donor without a right hepatic duct, 2 or more bile duct stumps will be present in the plane of transection in the graft in 3 patterns based on their relation to the portal vein. Accurate knowledge of the variations in the hepatic confluence is essential for successful living donor liver transplantation.
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