ABSTRACT
We herein report the use of an opened round ligament as a venous patch graft for inferior right hepatic vein (IRHV) reconstruction and anastomosis to the inferior vena cava (IVC) in living-donor liver transplantation (LDLT) using a right-lobe (RL) graft. After laparotomy, the donor's round ligament was harvested and opened, and the semi-transparent umbilical vein, which was 7.0 cm in length and 3.0 cm in width, was carefully trimmed on the back table for use as a patch graft. The right hepatic vein of the graft was anastomosed to the harvested patch, and the IRHV was anastomosed to an independent hole made in the wall on the other side of the patch, to form a bridged vascular patch for anastomosis to the IVC. The interposition graft filled promptly and provided a good outflow from the posterior segment. This is the first report of venous reconstruction using a donor's round ligament graft in RL-LDLT.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , End Stage Liver Disease/surgery , Hepatic Veins/surgery , Liver Transplantation/methods , Living Donors , Plastic Surgery Procedures/methods , Round Ligament of Uterus/transplantation , Adult , Anastomosis, Surgical/methods , Cholangitis, Sclerosing/complications , Colitis, Ulcerative/complications , End Stage Liver Disease/etiology , Female , Humans , Laparotomy , Male , Middle Aged , Tissue and Organ Harvesting/methods , Treatment Outcome , Umbilical Veins/surgery , Umbilical Veins/transplantation , Vena Cava, Inferior/surgery , Young AdultABSTRACT
BACKGROUND/PURPOSE: The availability of an appropriate vascular graft is a significant concern in an extensive hepatic resection with part of the vena cava. METHODS/RESULTS: The patient had multinodular hepatocellular carcinoma, occupying the whole posterior segment with a tumor thrombus bulging inside the vena cava. At laparotomy, a segment of the round ligament was procured for use as a patch graft. After the mobilization of the right-side liver without taking down the short hepatic veins, parenchymal resection was completed with the use of a hanging maneuver. The hepatic vena cava was semitotally side-clamped, followed by resection of the caval wall with the tumor thrombus, resulting in an en-bloc resection. The procured round ligament was opened, trimmed, and sutured to the vena cava as a patch graft, followed by smooth reperfusion. CONCLUSIONS: The use of an opened round ligament as a venous patch graft is an easy and feasible technique in patch reconstruction of the vena cava.
Subject(s)
Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Round Ligament of Uterus/transplantation , Vena Cava, Inferior/surgery , Aged , Female , Hepatectomy/methods , Humans , Male , Transplantation, HeterotopicABSTRACT
Mirizzi's syndrome is a rare complication of cholelithiasis, and type II (cholecystocholedochal fistula) can be a technical challenge due to inflammation and the biliary duct defect. We report two cases that were treated with a simple and little known technique that uses the round ligament as a plasty to seal the large bile duct defect.
Subject(s)
Biliary Fistula/surgery , Round Ligament of Uterus/transplantation , Aged , Biliary Fistula/pathology , Female , Humans , Male , Middle Aged , Severity of Illness Index , SyndromeABSTRACT
A deformidade em flexao do punho na paralisia cerebral e comum, sendo muito incapacitante para a funcao da mao e dos dedos. De 1980 a 1990, foram revistas 36 transferencias tendineas do pronador redondo para os extensores radiais do corpo. Os autores descrevem a tecnica cirurgica de via de acesso unico, empregada nos mais diferentes tipos clinicos de paralisia cerebral, e concluem por recomenda-la como possibilidade de correcao efetiva nesta deformidade.
