VASCULAR RECONSTRUCTION FOR INTRAOPERATIVE MAJOR VASCULAR INJURIES

Background, The purpose of this study was to find an effective and pre cise surgical procedure to cope with the major vascular injuries that might be encountered during hepato-biliary and pancreatic surgery, Mat erials and methods, Among the 220 cases of hepato-biliary and pancreat ic surgery from 1991 to 1995 in our department, 8 patients who sustain ed 13 different instances of vascular injury were reviewed retrospecti vely. Results, Five injuries occurred in the portal vein (PV), 4 in th e hepatic artery (HA), and 2 in the inferior vena cava (IVC), The repa ir procedures consisted of 2 direct closures, 2 resections of the inju red sites followed by the end to end anastomosis, 2 autologous venous grafts and 1 artificial vascular graft implantation, and 2 diversions of the arterial bloodflow of the middle colic artery and the gastroepi ploic artery to the injured HA, The reconstructed vessels showed posto perative obstructions in 2 cases, in which artificial vascular graft i mplantation and direct closure were used for the reconstruction, Concl usions, Based on the above findings, the use of an artificial graft an d a direct closure all contributed to the early postoperative obstruct ion of the reconstructed vessels, However, a diversion of the arterial bloodflow to the injured hepatic arteries was found to maintain a goo d postoperative patency in these cases.