Portal Venous Reconstruction in a Living Liver Donor With an Anomalous Hepatic Arterial and Portal Venous Anatomy

Hepatic arterial and portal venous anomalies in living liver donors are not uncommon. Modified surgical techniques may be required in such circumstances, although the safety of the living donor must always be given top priority. We describe here a successful portal venous reconstruction in a living donor with an anomalous hepatic arterial and portal venous anatomy in which the right anterior and posterior hepatic arteries encircled the main portal vein. Although such an anomaly of hepatic vessels was not frequently encountered, we should be able to alter the surgical strategy to deal with it. This case illustrates the importance of preoperative hepatic artery and portal venous evaluation in all living donors to identify the feasibility of modifying vessel anastomoses in living donors, as well as recipients, before living donor liver transplantation.