Problems related to hepatic veins in liver surgery
Bo Li and Yong-gang Wei
Department of Liver Surgery and Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, China

Knowledge about hepatic veins has increased dramatically in recent two decades majorly because of the increasing number of living donor liver transplantation (LDLT) and the advancement in skills of liver surgery. Injuries of hepatic veins in some difficult circumstances could result in major hemorrhage and outflow congestion as well as air embolism. Here we described our strategies to prevent and manage these problems. Preoperative investigation of the hepatic veins anatomy case by case using routine imaging modalities as well as 3-D reconstructed image could be helpful in designing a precise resection with functional parenchyma being reserved. Newly developed equipments could be useful in preventing and treating troublesome bleeding. In difficult cases such as echinococcus whose hepatic vein must be partially resected, in situ reconstruction may be a choice which could warrant enough outflow of the residual parenchyma thus avoid possible small-for-size syndrome. In right lobe LDLT, enough outflow is mandatory, reconstruction of the V, VIII segments outflow can be achieved using autologous great saphenous vein or cryopreserved cadaveric iliac artery, which can result in good outcome in recipients similar to extended right lobe LDLT by not compromising donor safety.