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Despite the development of surgical techniques, postoperative pancreatic fistula is still one of the main causes of serious morbidity after pancreaticoduodenectomy. Nevertheless numerous studies have been done, studies on preventing pancreatic fistula are lacking. This study is focused on the effectiveness of negative pressure external drainage for pancreaticojejunostomy in pancreaticoduodenectomy patients.Seventy-six patients were scheduled for pancreaticoduodenectomy at Soonchunhyang University Hospital from January of 2003 to August of 2007. Negative suction drainage group (n = 41) and no negative suction drainage group (n = 35) were compared by patient characteristics, parameters related to operation, and complications.There were no statistical differences between both groups in patient demographics and parameters related to operation. The complication rates were significantly lower in negative suction drainage group in terms of postoperative bleeding (P = 0.012), choledochojejunostomy leak (P = 0.014), and pancreatic fistula (P = 0.018).This retrospective study showed that external stenting with negative pressure suction drainage of the pancreatic duct has significantly reduced the rate of pancreatic fistula in duct-to-mucosa pancreaticojejunostomy with improved surgical outcomes.

Modified right lobe graft with middle hepatic vein reconstruction is commonly carried out in living donor liver transplantation these days. Cadaveric vascular graft has been widely used to maintain good outflow in middle hepatic vein tributaries. However, cadaveric donors are limited in Korea. This problem may be compensated with bovine pericardium. From April 2007, we experienced 4 cases of modified right lobe graft living donor liver transplantation using bovine pericardium. After donor hepatectomy, a 2-cm diameter cylinderic shape was made with the large sized bovine pericardium. V5 and V8 (greater than 5mm in diameter) were anastomosed to the bovine pericardium with end-to-side pattern. After reperfusion, it was anastomosed to the recipient's middle and left hepatic vein trunk. All patients recovered well and are currently remaining good liver function (3 to 11 months). Three cases maintain tolerable middle hepatic venous flow and have no congestion of right anterior sector in enhanced computerized tomography or in Doppler ultrasonography. Bovine pericardium can be one of the alternative materials for middle hepatic vein reconstruction of modified right lobe graft in the area of cadaveric organ shortage.

Surgical resection of liver metastases from colorectal cancer can offer long-term survival and cure in patients with metastatic colorectal cancer isolated to the liver. We present a case of a recurrent liver metastasis from rectal cancer, managed with ante-situm liver resection under total vascular exclusion and venovenous bypass with hypothermic perfusion. A 58-year-old man, who was diagnosed with liver metastasis from rectal cancer underwent a left lateral sectionectomy in January 2006. A recurrent lesion developed 1 year after the first hepatectomy. The tumor was 5 cm in size, locating at segments I, IV, and VIII. It was involved in the origin of middle hepatic vein and retro-hepatic vena cava. We performed ante-situm liver resection under total vascular exclusion and venovenous bypass with hypothermic perfusion. The patient remains well without recurrence for 12 months after the last operation. Ante-situm technique made it easy to approach and completely removes the recurrent lesion locating at hardly accessible site and having the incomplete removal risk by conventional liver resection. The authors also reconfirmed that repeat hepatectomy is valuable in recurrent colorectal liver metastases.