Detection of the Left Portal Vein during Laparoscopic Gastrectomy for Early Gastric Cancer

Abstract

We report here a case in which the left portal vein was detected during a laparoscopic gastrectomy for early gastric cancer. A 38-year-old woman who presented with epigastralgia developed early gastric cancer. Upper gastrointestinal endoscopy revealed a type 0-IIc lesion, 10 mm at its largest point, in the middle third of the stomach. Poorly differentiated adenocarcinoma was confirmed in biopsy specimens. We performed a laparoscopic pylorus-preserving gastrectomy with D1-plus lymphadenectomy and a gastrogastrostomy. During surgery, we observed that the left portal vein, which was an aberrant left gastric vein, directly entered the lateral segment of the liver through the hepatogastric ligament. The left portal vein was transected endoscopically near the lateral segment of the liver with lymphadenectomy of the lesser coverture of the stomach. The patient's postoperative course was uneventful, and maximum serum levels of AST and ALT were 139 U/l and 124 U/l, respectively. The patient was discharged 9 days after surgery and had no complications as an outpatient. The presence of a left portal vein is a very rare disorder, and, to the best of our knowledge, this is the first reported case of the left portal vein being detected during laparoscopic gastrectomy. Although left portal vein transection with lymphadenectomy was needed there were no postoperative complications, including liver dysfunction.