Impact of localized congestion related to venous deprivation after hepatectomy.

OBJECTIVE: We sought to assess the impact of localized venous congestion related to venous deprivation on liver function recovery and regeneration after hepatectomy, using the living donation model. Harvesting the middle hepatic vein (MHV) optimizes the venous drainage of right grafts but could lead to donor segment IV congestion.

METHODS: In a series of 44 donors, 25 underwent right liver harvesting without the MHV and 19 with the MHV. The venous drainage anatomy of segment IV was defined as type I if exclusive through the MHV and type II if shared through the left hepatic vein. We prospectively studied the occurrence, magnitude (global or partial), and regeneration impacts of segment IV congestion on computed tomography (CT) performed 1 week and 1 month after surgery.

RESULTS: Early postoperative CT showed that segment IV congestion was never observed in the group without MHV harvesting, and it was present in 16 (84%) of 19 donors with MHV harvesting. Segment IV congestion was global in 9 donors, including 7 with type I anatomy. Postoperative data comparing data of the 9 donors with global congestion (GC) with other donors showed that the prothrombin time was significantly (P < .05) lower on day 1 and 5 (53% vs 63% and 76% vs 86%, respectively), and segment IV regeneration rate was lower (3.6% vs 11%) in the former group. However, a higher regeneration rate of segments II and III in the GC group (11.8% vs 3.6%) resulted in a similar regeneration rate of the remnant liver 1 month after hepatectomy (59.4 +/- 12% vs 57.8 +/- 12.4%).

CONCLUSIONS: Postoperative localized venous congestion is highly related to venous anatomy and affects both early postoperative liver function and regeneration rate. Based on this living donor model, we suggest that venous anatomy evaluation of the future remnant liver parenchyma be performed systematically before extended resection of living small or diseased remnants.