Successful re-transection of conglutinated hepatic resection plane for repeated systematized hepatectomy

Although re-transection of a conglutinated hepatic resection plane is rarely necessary for repeated systematized hepatectomy, the operative procedure carries the risk of massive bleeding since it requires re-exposure of the main hepatic vein. We present a safe technique that allows successful re-transection of a tightly conglutinated resection plane. A 38-year-old man with liver metastasis of rectal cancer had undergone multiple repeated hepatic resections, including extended subsegmentectomy (segment 8), in which the middle hepatic vein was resected and the right hepatic vein was exposed on the resection plane of the right side. At presentation, the metastatic tumor located in segment 4 and the right hepatic vein was tightly conglutinated with the resection plane of segment 4. Segmentectomy (Segment 4) with re-transection of conglutinated resection plane was necessary for both curability of tumor and preservation of remnant hepatic function. Resection of the remaining common channel of the left and middle hepatic vein allowed the tightly conglutinated resection plane to be safely resected from the left side, which was loosely conglutinated. Moreover, wide re-exposure of the right hepatic vein from the root side allowed the control of any massive bleeding during this procedure. No blood transfusion was needed and the postoperative course was uneventful.