Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 8, 2016; 8(34): 1535-1540
Published online Dec 8, 2016. doi: 10.4254/wjh.v8.i34.1535
Major hepatectomy using the glissonean approach in cases of right umbilical portion
Yusuke Ome, Kazuyuki Kawamoto, Tae Bum Park, Tadashi Ito
Yusuke Ome, Kazuyuki Kawamoto, Tae Bum Park, Tadashi Ito, Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama 710-8602, Japan
Author contributions: Ome Y clinically managed the patients, performed the operations, gathered the clinical data, designed the report and wrote the paper; Kawamoto K, Park TB and Ito T supervised the clinical practices and helped draft and revise the manuscript.
Institutional review board statement: The Kurashiki Central Hospital Institutional Review Board does not require approval for case reports. Ethics approval was not necessary for this case report.
Informed consent statement: Written informed consent was obtained from the patients.
Conflict-of-interest statement: None of the authors have conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yusuke Ome, MD, Department of Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki City, Okayama 710-8602, Japan. yo14408@kchnet.or.jp
Telephone: +81-86-4220210 Fax: +81-86-4213424
Received: June 21, 2016
Peer-review started: June 24, 2016
First decision: August 11, 2016
Revised: September 11, 2016
Accepted: October 25, 2016
Article in press: October 27, 2016
Published online: December 8, 2016
Abstract

Right umbilical portion (RUP) is a rare congenital anomaly associated with anomalous ramifications of the hepatic vessels and biliary system. As such, major hepatectomy requires a careful approach. We describe the usefulness of the Glissonean approach in two patients with vessel anomalies, such as RUP. The first patient underwent a right anterior sectionectomy for intrahepatic cholangiocarcinoma. We encircled several Glissonean pedicles that entered the right anterior section along the right side of the RUP. We temporarily clamped each pedicle, confirmed the demarcation area, and finally cut them. The operation was performed safely and was successful. The second patient underwent a left trisectionectomy for perihilar cholangiocarcinoma. We secured the right posterior Glissonean pedicle. The vessels in the pedicle were preserved, and the other vessels and contents were resected. Identifying the vessels for preservation facilitated the safe lymphadenectomy and dissection of the vessels to be resected. We successfully performed the operation.

Keywords: Right anterior sectionectomy, Right umbilical portion, Glissonean approach, Left trisectionectomy, Glissonean pedicle, Cholangiocarcinoma, Hepatocellular carcinoma

Core tip: Right umbilical portion (RUP) is a rare congenital anomaly, and its presence is associated with anomalous ramifications of the hepatic artery, portal vein, and biliary system. Major Hepatectomies for patients with this anomaly are complicated and require a careful approach. The Glissonean approach is acknowledged as a successful technique. The targeted Glissonean pedicle to be resected or preserved is easily identified by clamping; thus, the Glissonean approach can be used in various situations of hepatic resection. This report describes the usefulness of the Glissonean technique, especially in cases with an anomaly, such as RUP.