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Hemihepatectomy and transfer of the portal inflow tract of the retained hemiliver in the dog.

The results of resection of cancers arising from the biliary tract or hilar portions of the liver might be improved by concomitant resection of all potentially involved regional lymphatics and vessels in the hepatoduodenal ligament. A method to replace the portal vein before its resection in combination with a hemihepatectomy was developed in 15 dogs. A second hepatic inflow tract for the portal blood was constructed by transposition of the splenic vein to an intrahepatic portal vein branch spared during hemihepatectomy. When this paraportal bypass had been shown to function well, the portal vein could be cut safely. Under the influence of the initially raised portal blood pressure, the bypass expanded in the next several weeks to a vessel almost as wide as the former portal vein, with concomitant normalization of the portal pressure and normal liver regeneration. Replacement of the portal vein as such by an adequate paraportal bypass enhances the resectable area of the liver hilus.