We have three standard procedures for hepatic vein reconstruction in left-sided graft implantation: (a) one orifice using all of the hepatic veins, (b) the left and middle hepatic vein orifices and an additional incision of the IVC, and (c) the right hepatic vein and an additional incision of the IVC (A).
Preparation of a single orifice by using all of the hepatic veins is shown in the following figures: The inferior vena cava is entirely clamped to include all hepatic venous stumps (B-1). All septa are opened to create a single hole (B-2) and the size is measured (B-3). If the hole is too large for the hepatic vein of the graft, the diameter is adjusted by 5-0 Prolene suture at the left corner of the hole. Stitches with double armed 5-0 Prolene or PDS are placed on the right and left corners (B-4). The posterior anastomosis is made by the intraluminal method. After accomplishing the anastomosis, another small vascular clamp is placed just proximal to the anastomosis and the large one is removed to resume blood flow of the inferior vena cava.
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