Should temporary extracorporeal continuous portal diversion replace meso/porta-caval shunts in “small-for-size” syndrome in porcine hepatectomy?

Core Tip

Core tip: Meso/porta-caval shunts have usually been adopted to relieve portal hyperperfusion in “small-for-size” syndrome (SFSS) or postoperative liver failure; however, these methods cannot dynamically adjust portal inflow to affect “functional competition”. In this study, extracorporeal continuous porta-caval diversion was temporarily adopted to relieve hyperperfusion, dynamically adjust the effect of portal inflow towards functional competition, and preserve optimal portal inflow. This also reduces injury to the sinusoidal endothelium, decreases endotoxin/bacterial translocation, and facilitates liver regeneration in SFSS after massive hepatectomy, and therefore could replace permanent meso/porta-caval shunts, which have no benefit or harm towards liver regeneration in late stages.