Use of ultrasonographic demonstration of hepatic venous flow to aid decisions on venous reconstruction during hepatectomy in a patient with an inferior right hepatic vein

If hepatic tumors involve the right hepatic vein (RHV) or the middle hepati c vein (MHV), the surgeon is forced to remove the vein during resection. Th is causes congestion of the hepatic venous now in the remaining caudal part of the liver parenchyma. Because such congestion occasionally induces hepa tic failure (particularly in patients with impaired liver function), recons truction of the major hepatic veins is required.(1) It has been shown that hepatectomy with resection of the RHV and without venous reconstruction is possible if the patient has an inferior right hepatic vein (IRHV).(2-5) L, this report, we describe a patient with an IRHV who underwent hepatectomy o f segments 7 and 8 and part of segment 4, along with resection of the RHV a nd MHV without reconstruction. We pay particular attention to the importanc e of using intraoperative color Doppler ultrasonography to visualize the he patic venous now.