Doppler assessment after right hepatectomy confirms the need to fix the remnant left liver in the anatomical position

Background: The remnant left liver after right hepatectomy tends to rotate spontaneously into the right subphrenic space. This rotation might induce venous outflow impairment. The aim of this study was to assess immediate venous outflow in the left hepatic vein by intraoperative Doppler ultrasound (US) according to the position of the remnant liver. Methods: From August 2003 to February 2004, assessment of left hepatic venous outflow was systematically performed in 44 consecutive right hepatic resections by Doppler US in spontaneous and anatomical positions. The anatomical position was defined as the position in which the falciform ligament was in its strict median position. Results: The placement of the left liver from the spontaneous position to the anatomical position resulted in a significant increase in left hepatic venous outflow (20.1 +/- 5.7 versus 8.5 +/- 4.4 cm/s; P < 0.0001). In the spontaneous position, the decrease in left hepatic venous outflow persisted even without division of the left triangular ligament (10.2 +/- 5.4 versus 21.7 +/- 5.3 cm/s in the anatomical position) or removal of the middle hepatic vein (8.4 +/- 3.4 versus 21.3 +/- 5.8 cm/s). Conclusion: Results of this study strongly suggest that after right hepatectomy the remnant left liver should always be fixed in the anatomical position.