Published online Dec 8, 2016. doi: 10.4254/wjh.v8.i34.1535
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
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.
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.