One orifice vein reconstruction in left liver plus caudate lobe grafts.

For maximum use of left liver plus caudate lobe grafts, the short hepatic vein draining the caudate lobe should be reconstructed. We devised a new venoplasty technique. On the graft side, a wide venous orifice with a long cuff was formed by gathering the left, middle, and short hepatic veins using a conduit vein graft and patch vein grafts. On the recipient side, three hepatic veins were connected to make a wide orifice. The liver graft was then connected to the recipient vena cava with a wide outflow tract and a venous reservoir. This new technique was adopted in 12 patients and the short-term results of this technique were satisfactory. The present procedure should simplify venous reconstruction in the recipient and might be useful to prevent hepatic venous stenosis resulting from graft regeneration.