Case Report
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2011; 17(30): 3554-3559
Published online Aug 14, 2011. doi: 10.3748/wjg.v17.i30.3554
Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy
Hiroya Iida, Chiaki Yasui, Tsukasa Aihara, Shinichi Ikuta, Hidenori Yoshie, Naoki Yamanaka
Hiroya Iida, Chiaki Yasui, Tsukasa Aihara, Shinichi Ikuta, Hidenori Yoshie, Naoki Yamanaka, Department of Surgery, Meiwa Hospital 4-31 Agenaruo-cho, Nisinomiya, 663-8186 Hyogo, Japan
Author contributions: Iida H contributed to this work; Iida H and Yamanaka N designed the research; Iida H, Yasui C, Aihara T, Ikuta S and Yoshie H performed the research; Iida H and Yamanaka N analyzed the data.
Correspondence to: Hiroya Iida, MD, Department of Surgery, Meiwa Hospital 4-31 Agenaruo-cho, Nisinomiya, 663-8186 Hyogo, Japan. hiroya0001@mac.com
Telephone: +81-798-471767 Fax: +81-798-477613
Received: September 22, 2010
Revised: December 21, 2010
Accepted: December 28, 2010
Published online: August 14, 2011
Abstract

Hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer; however, one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver, which may cause postoperative liver failure. To induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver, procedures to occlude the portal vein have been conventionally used prior to major hepatectomy. We report a case of a 50-year-old woman in whom two-stage hepatectomy was performed in combination with intraoperative ligation of the portal vein and the bile duct of the right hepatic lobe. This procedure was designed to promote the atrophic effect on the right hepatic lobe more effectively than the conventional technique, and to the best of our knowledge, it was used for the first time in the present case. Despite successful induction of liver volume shift as well as the following procedure, the patient died of subsequent liver failure after developing recurrent tumors. We discuss the first case in which simultaneous ligation of the portal vein and the biliary system was successfully applied as part of the first step of two-stage hepatectomy.

Keywords: Two-stage hepatectomy; Bile duct ligation; Portal vein ligation; Synchronous liver metastases