Access to the retroperitoneum for portocaval anastomosis is obtained with a midline incision. An Omnitract or Octopus retractor aids exposure. The cecum and right colon are mobilized medially to expose the vena cava. Care should be taken to avoid injury to the right ureter that may cross the iliac vessels on the right side at several different levels, either at the caval bifurcation or more laterally. The ureter is retracted laterally. During preparation of the vena cava for anastomosis (~5 cm needed), the surgeon must remember the sacral vein located posteriorly, usually just cephalad to the iliac bifurcation. The right common iliac artery is prepared similarly. Lymphatic vessels should be ligated to avoid formation of a lymphocele.
Was this article helpful?
For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.