[Preoperative portal vein embolization]

ABSTRACT

The liver failure is a severe complication of major hepatectmies. Preoperative portal vein embolization allows a prior interruption of the portal flow in the liver territories that are to be resected, inducing their atrophy and the compensatory hypertrophy of the futur liver that persists after this removal. It is interesting to discuss the feasibility of this technique in our contexte starling from accessibles means for obtaining satisfactory results. Patient aged 55 years old, who presented for two months a cholestatic jaundice cutaneous mucosal. The Magnetic Resonnance Imaging abdominal showed an appearance very evocative of a cholangiocarcinoma of the biliary confluence reaching the right hepatic duct type IIIA of bisthmuth and cornette. Three weeks after portal vein embolization, an hypertrophy of the futur remaining liver is obtained. Finally, we perfomed a right hepatectomy extended to segments IV anterior and I. The postoperative course was uneventful. The major hepatectomy carries the risk of postoperative liver failure. Portal vein embolization of the liver to resect aims to redistribute the portal flow to induce a hypertrophy of the futur liver remnant. Portal obstruction can be used by an embolization with biological glue, acrylic adhesives, alcohol, or by a ligation. It can be done by ultrasound guided percutaneous transhepatic or by catheterization of an ileocolic vein. However, given the specific equipment required for the percutaneous and human skills still not widespread, it is best in our context the ileal way that is accessible to all surgeons and also effective. Major liver surgery is developing in our country, thus preoperative portal vein embolization can now make extensive liver resections with less risk and complications