Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2879-2887
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2879
Repair of the portal vein using a hepatic ligamentum teres patch for laparoscopic pancreatoduodenectomy: A case report
Qiang Wei, Qiang-Pu Chen, Qing-Hai Guan, Wen-Tao Zhu
Qiang Wei, Qiang-Pu Chen, Qing-Hai Guan, Wen-Tao Zhu, Department of Hepatobiliary Surgery and Clinical Nutrition Center, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
Author contributions: Wei Q drafted the manuscript; Chen QP performed the operation, designed the report, and revised the manuscript; Guan QH and Zhu WT were involved in editing the manuscript; all authors managed the case and participated in the operation.
Informed consent statement: Written informed consent was obtained from this patient, or her legal guardian.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article are reported.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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/
Corresponding author: Qiang-Pu Chen, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Hepatobiliary Surgery and Clinical Nutrition Center, Binzhou Medical University Hospital, 661 Huangheer Road, Bincheng District, Binzhou 256600, Shandong Province, China. drcqp@263.net
Telephone: +86-13561559269 Fax: +86-543-3258597
Received: April 6, 2019
Peer-review started: April 8, 2019
First decision: June 19, 2019
Revised: June 23, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: September 26, 2019
Processing time: 171 Days and 7.3 Hours
Abstract
BACKGROUND

Laparoscopic pancreatoduodenectomy (LPD) has been developed gradually with the advances in surgical laparoscopic techniques. It is technically challenging to perform LPD with portal vein resection and reconstruction.

CASE SUMMARY

A 71-year-old female patient was diagnosed with distal cholangiocarcinoma. After preoperative examination and rigorous preoperative preparation, the patient underwent LPD using 3D laparoscopy on July 17, 2018. During the surgery, we found that the tumor invaded the right wall of the portal vein; thus, pancreaticoduodenectomy combined with partial portal vein wall resection was performed. The defect of the portal vein wall was approximately 2.5 cm × 1.0 cm. The hepatic ligamentum teres was excised by laparoscopy and then recanalized in vitro. Following recanalization, the hepatic ligamentum teres was cut longitudinally and then trimmed into vascular patches that were then used to reconstruct the defect of the portal vein through 3D laparoscopy. The operative time was 560 min, and intraoperative blood loss was 100 mL. The duration of the blood occlusion time was 63 min. No blood transfusion was required. The patient underwent enhanced recovery after surgery procedures after the operation. The patient was discharged on postoperative day 11. Follow-up for 6 months after discharge showed no stenosis of the portal vein and good patency of blood flow.

CONCLUSION

It is safe and feasible to use the hepatic ligamentum teres patch to repair portal vein in LPD. However, the long-term patency of this technique for venous reconstruction requires further investigation.

Keywords: Hepatic ligamentum teres patch; Laparoscopic pancreatoduodenectomy; Portal vein repair; Case report

Core tip: We report a patient with distal cholangiocarcinoma that invaded the portal vein who was treated by laparoscopic pancreatoduodenectomy and using the hepatic ligamentum teres patch to repair the portal vein by laparoscopy. Use of the hepatic ligamentum teres patch to repair and reconstruct the portal vein/superior mesenteric vein by laparoscopy is difficult and complicated. It was confirmed that laparoscopic treatment of tumors that invade the portal vein or superior mesenteric vein is safe and feasible. Furthermore, the application of the hepatic ligamentum teres patch in the reconstruction of abdominal blood vessels was further expanded and reduced the incidence of transabdominal operation.