# Right hepatectomy in absence of the left portal vein using the porto-rex shunt procedure

## TL;DR

A rare case of liver surgery used a porto-rex shunt to safely remove a tumor when standard methods were not possible due to unusual blood vessel anatomy.

## Contribution

Demonstrates the successful use of a porto-rex shunt in a rare anatomical variation to enable right hepatectomy.

## Key findings

- A porto-rex shunt maintained blood flow to the left liver lobe during surgery.
- The tumor was successfully removed with tumor-free resection margins.
- The procedure highlights the importance of preoperative vascular assessment in complex cases.

## Abstract

Exact knowledge of the portal vein (PV) anatomy is essential for any hepatobiliary procedure. Absence of the portal bifurcation with the complete blood flow to the left lobe coming from the right portal vein (RPV) is an extremely rare anatomical variation.

In this situation, a solitary metachronous colorectal liver metastasis with suspected infiltration of the RPV and the right bile duct was detected in a 51-year-old male patient. Neither percutaneous ablation nor stereotactic radiotherapy were considered indicated due to the close proximity to the central structures. Hence, a surgical two-step procedure was scheduled. First, a porto-rex shunt with an 8 mm PTFE graft to maintain the portal blood flow to the left lobe was performed. In addition, the RPV was ligated during the same procedure. After recovery, the procedure was completed with a right hepatectomy. The final pathological report confirmed invasion of the right bile duct and the RPV and resection margins were tumor-free.

This case shows that careful preoperative assessment of vascular anatomy is critical. The use of the porto-rex shunt allowed a potentially curative resection in an otherwise irresectable situation.