A case of hepatoduodenal ligamentectomy after transcatheter arterial embolization (TAE) of the proper hepatic artery (PHA) for middle bile duct carcinoma

Abstract

We experienced a case of hepatoduodenal ligamentectomy after transcatheter arterial embolization (TAE) of the proper hepatic artery (PHA) for middle bile duct carcinoma. A 55-year-old man was admitted with liver dysfunction. Preoperative diagnosis was middle bile duct carcinoma with invasion to hepatoduodenal ligament. Angiography revealed replaced left hepatic artery (RLHA)from left gastric artery. TAE of the PHA was performed in order to develop intrahepatic collateral circulation preoperatively. Three weeks after TAE, angiography revealed intrahepatic collaterals from RLHA developed. Liver function after TAE was normal. Hepatoduodenal ligamentectomy and pylorus preserving pancreatoduodenectomy was performed. Portal vein was reconstructed by end to end direct anastotnosis, without reconstruction of the hepatic artery. The postoperative courses were uneventful. Liver function returned to almost normal values within 5 days of the operation. Thirty-four days after the operation, the patient was discharged. Preoperative TAE of the PHA would be a procedure that might enable hepatoduodenal ligamentectomy safely without reconstruction of the hepatic artery.