Background: In children, hemodynamic disturbances may occur due to portal vein (PV) hypoplasia. In cases like this, PV reconstruction is usually performed using vein graft. We present a successful anastomosis between the distal part of hypoplasic recipient PV including confluence and the donor PV without the use of a graft.
Methods: Our case with biliary atresia was 18 months old and weighed 8 kilos. Her model for pediatric end-stage liver disease score was 22.2. Vascular structures were evaluated with preoperative CT angiography (CTA) and no flow could be seen in PV. Living donor LT was performed from her father. To obtain sufficient front flow into the graft, the main collateral vessels of the portal system were ligated. The hypoplasic PV was dissected until the cofluence of superior mesenteric vein and splenic vein. Intraoperative measurement showed that the diameter of the distal part of the portal vein was less than 2 mm. The graft portal vein was anastomosed with a lateral incision 9 mm proximal part to confluence with 6-0 polydioxanone monofilaments. Intravenous heparin infusion was given for the first 1 week postoperatively and portal vein flow monitoring was performed with Doppler ultrasonography.
Results: Doppler ultrasonography on postoperative day was 2 revealed stenosis in the portal vein. This stenosis was were treated with a course of percutaneous transhepatic PV dilatation and stent placement.
Conclusions: In cases of diameter mismatch between the recipient and graft portal vein due to portal vein stenosis in biliary atresia, graft use may cause unexpected morbidity in the recipient or donor. Therefore, with careful dissections using microsurgical techniques in an experienced center, successful results can be achieved without the use of grafts with anastomoses to areas with suitable diameter for anastomosis such as superior mesenteric vein-splenic vein confluence.