Different techniques can be used for portal vein preparation (A), including: (a) with a branch patch, (b) with an oblique incision, (c) graft interposition, and (d) a patch graft. The first two are the simplest and most frequently used to adjust the graft size of the portal vein. If the portal vein wall is damaged or narrow, it should be changed with a venous graft. When the available venous graft is too small for interposition, the patch graft technique using a patch made from a small venous graft which is longitudinally opened is recommended.
Before the portal anastomosis is started, the portal vein should be briefly undamped and washed with heparinized saline to check the flow and to remove possible coagula. The anastomosis is started by placing two double armed 6-0 Prolene or PDS sutures at the right and left corner of the graft portal vein. Anastomosis of the posterior wall is first carried out from the inside, in a running suture fashion. During the anastomosis, the suturing stitch should be kept loose to prevent anastomotic stricture (B). When this technique is used, creation of a growth factor is not required.
This continuous suture is our standard technique in most cases. However, interrupted sutures are used for the anterior wall subsequent to a running suture for the posterior wall in cases of a size mismatch or a small diameter using 7-0 Prolene or PDS.
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