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The left gastric vein was divided at its junction with the portal vein and connected to the vena cava using a left external iliac vein graft through the omental foramen. After this procedure, the pleural effusion and ascites disappeared, blood ammonium level decreased to normal, and Child-Pugh score decreased to 9. Using the Inokuchi shunt procedure, the portosystemic shunt, via the left gastric vein, was closed to increase portal blood flow and improve liver function. As a less invasive procedure, hybrid laparoscopic approach should be co
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