A Study on Type of Branching Patterns of Right Portal Vein

Abstract

The right hepatic lobe transplantation is usually the procedure of choice to provide adequate liver volume to the recipient. Variant vascular and biliary anatomy is more common in the right lobe. Knowledge of anatomical variants is valuable in preoperative planning, particularly in considering donor candidates for adult-to-adult liver transplantation, whereby typically the right lobe of the donor is transplanted to the recipient. The present study was done to identify the branching patterns of right portal vein and to know their importance in management of living donor liver transplantation surgeries. Material and Methods:The present study was conducted on 84 liver specimens of human cadavers fixed with 10% formalin, collected from the Department of Anatomy and Forensic Medicine, MMC&RI, Mysore.Results: Bifurcation of RPV was seen in 30 specimens (35.7%). Trifurcation of RPV was seen in 5 specimens (6%). Quadrification of RPV was seen in 18 specimens (21.4%). Arched pattern of RPV was seen in 15 specimens (17.9%). Premature origin of segment V and segment VIII vein from RPV, then trunk of RPV dividing terminally into segment VI and segment VII vein was seen in 2 specimens (2.4%). Unusual pattern of division of RPV was seen in 10 specimens (12%). In rest of 4 specimens there was no RPV as Right anterior and Right posterior portal veins were directly arising from Main portal vein. Conclusion:Anatomical variations of the liver vasculature and bile ducts are common and their recognition and management is critical in living donor liver transplantation. Although anomalies of the right lobe are commonly encountered, a relatively limited number of cases will significantly complicate the resection and transplantation. Main advantage of right lobe transplantation is the large size of graft and surgical management of both donor and recipient anatomical variations is considerably simpler than with left sided graft.