Precaution against postoperative venous complications after major hepatectomy using the pedicled omental transposition flap: Report of two cases

• We report two successful cases to prevent vascular complications following hepatectomy.
• Dead space usually develops the surrounding area of major vessels following hepatectomy.
• It leads to kinking and torsion of the major vessels including portal and hepatic vein.
• We used the omental flap to fill the dead space developed adjacent to the major vessels.
• Omental flap is simple procedure and feasible to fill the dead space by its mass effect.

INTRODUCTIONVascular complications following hepato-pancreatic biliary surgery can be devastating, and therefore precaution of them must be critical. We report two cases in which the pedicled omental transposition flap might be effective to avoid postoperative venous complications following major hepatectomy.PRESENTATION OF CASECase 1 is a 80-year-old male who required to perform re-laparotomy at postoperative day 1 following major hepatectomy due to acute portal venous thrombosis (PVT). In the second surgery, the main trunk of PV was occluded by thrombus resulted from its redundancy and kinking. PV was resected with an adequate length and reconstructed. The omental flap was placed between PV and inferior vena cava (IVC) to fill in the dead space, resulting in favorable intrahepatic portal blood flow. Case 2 is a 64-year-old male who underwent left trisectionectomy because of giant hepatocellular carcinoma located close to the trunk of right hepatic vein (RHV) and IVC. After removal of the specimens, the dead space developed between the RHV and IVC. In order to prevent outflow block caused by kinking of the RHV, the omental flap was placed between the RHV and IVC, and the right triangle ligament of the liver was fixed to the diaphragm. RHV patency was confirmed by postoperative imaging.DISCUSSIONThe omental flap is a simple procedure and useful to fill the dead space developed in the area surrounding major vessels.CONCLUSIONSWe experienced two cases in which vascular complications might be avoided by filling the dead space surrounding major vessels using the omental flap.