Beneficial use of the round ligament as a patch graft for vena cava reconstruction

Ikegami, Toru; Shimada, Mitsuo; Imura, Satoru; Morine, Yuji; Kanemura, Hirofumi; Mori, Hiroki; Arakawa, Yusuke; Hanaoka, Jun

doi:10.1007/s00534-007-1319-1

Cited by 16 publications

(11 citation statements)

References 15 publications

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“…Hepatic round ligament (HRL), also called the ligamentum teres hepatis , is the remnant of the fetal umbilical vein and is connected to the falciform ligament. This ligament is well vascularized and extensible [ 16 ], and can therefore be harvested for enhancing venous- [ 17 ] or pancreatico-enterostomy[ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Use of an Autologous Liver Round Ligament Flap Zeros Postoperative Bile Leak after Curative Resection of Hilar Cholangiocarcinoma

et al. 2015

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BackgroundPostoperative bile leak is a major surgical morbidity after curative resection with hepaticojejunostomy for hilar cholangiocarcinoma, especially in Bismuth-Corlette types III and IV. This retrospective study assessed the effectiveness and safety of an autologous hepatic round ligament flap (AHRLF) for reducing bile leak after hilar hepaticojejunostomy.MethodsNine type III and IV hilar cholangiocarcinoma patients were consecutively hospitalized for elective perihilar partial hepatectomy with hilar hepaticojejunostomy using an AHRLF between October 2009 and September 2013. The AHRLF was harvested to reinforce the perihilar hepaticojejunostomy. Main outcome measures included operative time, blood loss, postoperative recovery times, morbidity, bile leak, R0 resection rate, and overall survival.ResultsAll patients underwent uneventful R0 resection with hilar hepaticojejunostomy. No patient experienced postoperative bile leak.ConclusionsThe AHRLF was associated with lack of bile leak after curative perihilar hepatectomy with hepaticojejunostomy for hilar cholangiocarcinoma, without compromising oncologic safety, and is recommended in selected patients.

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Section: Introductionmentioning

confidence: 99%

Use of an Autologous Liver Round Ligament Flap Zeros Postoperative Bile Leak after Curative Resection of Hilar Cholangiocarcinoma

et al. 2015

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“…The efficacy of various venous grafts used in HV reconstruction has been reported. These grafts include auto-venous grafts (from the inferior mesenteric vein, gonadal vein, external iliac vein, internal jugular vein, and saphenous vein)[ 13 , 15 , 16 ], venous grafts from a living donor, native portal veins[ 17 ], opened round ligaments[ 4 - 9 , 12 ], cryopreserved homografts[ 18 - 22 ], and polytetrafluoroethylene grafts[ 23 , 24 ]. However, the harvest of a venous graft from a living donor or the recipient himself is not easy.…”

Section: Discussionmentioning

confidence: 99%

“…The use of the opened round ligament as a venous patch graft has become accepted in hepatopancreatobiliary surgery because of its easy availability[ 1 - 3 ]. Recent studies have demonstrated the use of the opened round ligament as a venous patch graft in hepatic venous reconstruction during living donor liver transplantation (LDLT)[ 4 - 7 ]. However, there is no consensus regarding the efficacy of using the opened round ligament as a venous patch graft.…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

Sanada¹,

Sakuma²,

Sasanuma³

et al. 2016

WJG

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Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor’s opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient’s HV and the donor’s opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology.

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“…Although the case volume is limited, a higher incidence of thrombosis has been reported with the use of the opened round ligament as a long conduit . Yamanaka et al reported thrombosis in 2 of 6 patients who received cylindrically opened round ligaments for portal system reconstruction; these patients received grafts that were >3 cm long.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports have proposed that the round ligament could be used as a venous patch graft in hepatobiliary surgeries . Nevertheless, there are several heterogeneous types of round ligaments, including unclosed umbilical veins procured during newborn delivery, spontaneously recanalized paraumbilical shunt vessels caused by liver cirrhosis, and manually opened and dilated round ligaments in adults . The opened round ligament, which is procured during laparotomy, could be procured from most donors and might be particularly useful for hepatobiliary surgeries, including LDLT .…”

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confidence: 99%

Pathological analysis of opened round ligaments as venous patch grafts in living donor liver transplantation

et al. 2013

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Although the round ligament, including the umbilical vein, could be used as a venous graft in living donor liver transplantation (LDLT), no studies have determined its appropriate use on the basis of pathological findings. We prospectively examined 19 LDLT cases in which the donor's round ligament was procured and used as a venous graft. The round ligaments were categorized into 3 types based on the CD31 immunohistochemistry of tissue cross-sections: (I) canalized umbilical veins (n 5 7 or 36.8%), (II) capillary umbilical vessels (n 5 4 or 21.1%), and (III) occluded umbilical veins (n 5 8 or 42.1%). After dilatation and incision, the round ligaments provided patch grafts that were 5.8 6 0.4 cm long and 1.8 6 1.2 cm wide. However, histological studies showed the absence of fine intimal layers on the dilated round ligaments after mechanical maneuvers. The ligaments were used to cuff the venous orifices in 15 patients (left lobe, n 5 8; right lobe, n 5 7) and were used as venous bridges in 4 patients (left lobe, n 5 2; right lobe, n 5 2). We detected no thrombosis at the implant sites after LDLT. Our pathological findings indicate that opened round ligaments can be used safely as venous patch grafts in LDLT.

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Beneficial use of the round ligament as a patch graft for vena cava reconstruction

Abstract: 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.

Cited by 16 publications

References 15 publications

Use of an Autologous Liver Round Ligament Flap Zeros Postoperative Bile Leak after Curative Resection of Hilar Cholangiocarcinoma

Use of an Autologous Liver Round Ligament Flap Zeros Postoperative Bile Leak after Curative Resection of Hilar Cholangiocarcinoma

Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

Pathological analysis of opened round ligaments as venous patch grafts in living donor liver transplantation

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