A Monograph on Anatomy and Variants of Hepatic Resectional Surgery

Danilo Coco; Silvana Leanza; Massimo Giuseppe Viola

doi:10.3889/oamjms.2024.11861

Authors

Danilo Coco Department of General Surgery, Giglio Hospital Foundation, Cefalu’, Italy https://orcid.org/0000-0002-5839-1767
Silvana Leanza Department of General Surgery, Giglio Hospital Foundation, Cefalu’, Italy https://orcid.org/0000-0001-8672-7486
Massimo Giuseppe Viola Department of General Surgery, Giglio Hospital Foundation, Cefalu’, Italy

DOI:

https://doi.org/10.3889/oamjms.2024.11861

Keywords:

Anatomy, Right hepatectomy, Wide resection, Variants

Abstract

BACKGROUND: The liver anatomy appears to be very complex due to the enormous number of vascular and biliary branches as well as the fact that the underlying pathology frequently distorts the anatomy. To prevent damage during surgical or invasive procedures, it is advised to be aware of the arteries’ typical structure and variations. Hepatic surgeons, general surgeons, transplant surgeons, interventional radiologists, and other medical specialists who treat liver problems must have this knowledge.

MATERIALS AND METHODS: We have retrospectively evaluated the PubMed databases, Embase, and the Cochrane Library by applying various combinations of subject-related terms. The search terms identified with the medical subject heading were “Anatomy, right hepatectomy, resection, variants.” The databases were used to collect the literature published since 1991.

RESULTS: Results delineated that 91.6% of patients had a single right hepatic vein, 81% shared a trunk with their middle hepatic vein (MHV) and left hepatic vein (LHV), and 19% had separate MHV and LHV drainage into the inferior vena cava. Overall prevalences of the abnormal hepatic artery, abnormal right hepatic artery (aRHA), abnormal left hepatic artery (aLHA), and combined aRHA/aLHA were found to be 27.41%, 15.63%, 16.32%, and 4.53%, respectively. The most common variation (type 2) is the so-called “portal vein (PV) trifurcation,” in which the main PV divides into the left PV, the right anterior PV, and the right posterior PV. The right posterior sectoral duct joins the left hepatic duct with a supraportal course, the right posterior sectoral duct joins the right anterior sectoral duct with an infraportal course, the trifurcation variation of the biliary tree, retroportal course, and the left lateral segmental ducts caudal to the umbilical portion of the PV are examples of variant biliary anatomy encountered in PV variations. Duplication of the common bile duct is a very uncommon congenital biliary system defect.

CONCLUSION: It is very crucial for surgeon to have abreast knowledge of the tributaries, their anatomy, and variations to limit blood loss and operative morbidities.

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