Technique of antegrade intraoperative cholangiography not requiring hepatic hilar dissection during repeated hepatectomy for hepatocellular carcinoma.

It is important to perform intraoperative cholangiography (IOC) during liver resection in order to detect bile leaks, but its performance is not so simple during repeat hepatectomy. We describe the technique of antegrade intraoperative cholangiography not requiring hepatic hilar dissection during repeated hepatectomy. The patient was a 35-year-old female who had undergone 4 previous operations for hepatocellular carcinoma. During the fifth operation, it was not possible to dissect the hepatic hilum only for taking IOC because of heavy adhesion. A small-sized intrahepatic glissonian branch was isolated during parenchymal transection, which was later used for an infusion route of IOC. A 24-gauge angiocatheter was inserted into the intrahepatic bile duct stump and tied over the whole glissonian pedicle stump. An IOC was successfully taken through this catheter and the glissonian pedicle stump was ligated after a leak test using methylene blue solution. At 32 months after this hepatectomy, she underwent deceased- donor liver transplantation due to hepatic failure from bile duct invasion by recurrent tumor. During recipient hepatectomy, previous minimal hilar dissection appeared very beneficial because some of the hilar structures remained undissected. This technique of antegrade IOC through the intrahepatic bile duct within the glissonian pedicle allows for an IOC without additional manipulation of the hepatoduodenal ligament when the cystic duct stump is not available.