Introduction: We report our experiences of type 2 portal vein and bile duct anastomosis during living donor liver transplantation
Case: Forty-four years old man was admitted for generalized weakness. He suffered from CVH-B for 20 years and 2years ago diagnosed LC with HCC. Primary HCC was treated by percutaneous RFA and recurred HCC was by TACE twice. After TACE generalized weakness, ascites were progressed. Hepatic encephalopathy was developed. Living donor liver transplantation was decided. Donor was 27-year-old son. GRWR was 1.48. Preoperative donor abdomen CT scan was revealed trifurcation of portal vein and low-lying right posterior hepatic duct. Middle hepatic vein branches were double in S5 and single in S8 level. Donor hepatectomy was performed as modified extended right hepatectomy (weight = 850gm). During bench operation neo-middle hepatic vein was reconstructed by use of iliac vein allograft. Lumens of graft portal vein were double. So left saphenous vein autograft patch was fenced to the graft portal veins for making single lumen. Graft was transplanted to recipient from right hepatic vein, portal vein, neo-middle hepatic vein and then right hepatic artery. Bile ducts were make common cannel in manner of V-shaped plasty then anastomosed to recipient bile duct. Total operation time was 632 minutes cold ischemic time was 40 minutes for bench operation. Maximal AST/ALT was 230/207IU/ml at POD #1 then normalized at POD #5 and #15 each. Postoperative abdomen CT revealed patent portal vein, neo-middle hepatic vein and hepatic artery. There was no congestion area in the transplanted liver. Patient was discharged at POD #34. There was no stricture or stenosis in anastomosis site in veins, artery and bile duct.
Conclusion: In the living donor liver transplantation, there were many anatomical difficulties in anastomosis due to anatomical variation especially in portal vein and bile duct. Portal vein fencing and bile-ductoplasty can be a good choice.