Gasque Rodrigo Antonio, Cervantes José Gabriel, Beltrame Magalí Chahdi, Virreira Marcelo Enrique Lenz, Mattera Francisco Juan, Quiñonez Emilio Gastón
HPB Surgery and Liver Transplantation Unit, Hospital de Alta Complejidad "El Cruce", Buenos Aires, Argentina.
Ann Hepatobiliary Pancreat Surg. 2025 May 31;29(2):187-191. doi: 10.14701/ahbps.24-217. Epub 2025 Feb 18.
The liver hanging maneuver (LHM), introduced by Belghiti et al. in 2001, has been widely adapted to various hepatectomy techniques to reduce blood loss and facilitate parenchymal transection. However, its primary limitation is the risk of vascular injury, particularly near the inferior vena cava (IVC). In this report, we describe a modified "Loop-Hanging" maneuver designed as an alternative to enhance exposure during parenchymal transection and improve the control of Glissonean pedicles. In this case, we employed the technique during an open right hemihepatectomy on a 47-year-old male patient with a complex bile duct injury following two unsuccessful Roux-en-Y hepaticojejunostomies (RYHJ). The patient was referred to our institution due to an RYHJ stricture. Imaging identified a right hepatic artery pseudoaneurysm and a fistula to the biliary limb. After two failed attempts at endovascular embolization, a surgical approach was determined through multidisciplinary discussions. During the surgery, the liver was looped with a nasogastric tube positioned anterior to the IVC, allowing gentle upward traction that facilitated the transection, minimized bleeding, and enhanced pedicle control. The LHM is known to reduce blood loss but carries risks for patients with anatomical variations, scarring, or cirrhosis. Our "Loop-Hanging" technique retains the core advantages of LHM, simplifies the process, and diminishes the risk of vascular injury. Further research is required to assess its safety and broader applicability.
肝脏悬吊法（LHM）由贝尔吉蒂等人于2001年提出，已广泛应用于各种肝切除术技术，以减少失血并便于实质离断。然而，其主要局限性是血管损伤风险，尤其是在下腔静脉（IVC）附近。在本报告中，我们描述了一种改良的“套圈悬吊”法，旨在作为一种替代方法，以增强实质离断过程中的暴露并改善肝门蒂的控制。在此病例中，我们在一名47岁男性患者的开放性右半肝切除术中采用了该技术，该患者在两次Roux-en-Y肝空肠吻合术（RYHJ）失败后出现复杂胆管损伤。患者因RYHJ狭窄转诊至我院。影像学检查发现右肝动脉假性动脉瘤和与胆支的瘘管。在两次血管内栓塞尝试失败后，通过多学科讨论确定了手术方案。手术过程中，用一根鼻胃管在IVC前方环绕肝脏，进行轻柔的向上牵引，便于离断，减少出血，并增强对肝门蒂的控制。已知LHM可减少失血，但对于存在解剖变异、瘢痕形成或肝硬化的患者有风险。我们的“套圈悬吊”技术保留了LHM的核心优势，简化了操作过程，并降低了血管损伤风险。需要进一步研究以评估其安全性和更广泛的适用性。
