Anatomical variations of liver blood supply in patients with pancreaticobiliary maljunction

Abstract

The incidence of the right hepatic artery being located on the ventral side of the common bile duct may be higher in patients with PBM than the naturally occurring incidence of about 10 % in the general Japanese population.

Congenital biliary dilatation in the era of laparoscopic surgery, focusing on the high incidence of anatomical variations of the right hepatic artery

“…Another study reported a correlation between PBM and a high incidence of the anterior course of the RHA (21%). 9 The same study reported that 63% of the patients with PBM had concomitant CBD, which suggests an important correlation between the anterior course of the RHA and CBD, 9 as seen in our study. Some anatomical variations of the pancreas and bile duct systems may arise in the process of embryonic development.…”

“…In the current study, the CHD was divided at the caudal side of the RHA in 92% of patients with the anterior type of RHA, and in 54% of patients with the posterior type of RHA. Based on our experience, it was relatively easy to detect and preserve the anterior type of RHA during surgery for CBD; however, Shinozaki et al 9 reported that the RHA crossing anterior to the CHD may be misidentified as fibrous connecting tissue and is sometimes divided due to stretching caused by the dilated duct. Thus, surgeons need to be aware of the need to detect the anterior type of RHA, and should tape the RHA before dissecting and encircling the dilated duct.…”

“…CBD is also frequently associated with anatomical variations of the vascular and biliary system. [8][9][10] Surgical management of CBD consists of excision of the dilated duct with cholecystectomy followed by biliary reconstruction. 11 We reported our first experience with laparoscopy-assisted surgery for CBD followed by Roux-en-Y hepaticojejunostomy in an adult patient in 1998, 12 and subsequently reported laparoscopy-assisted surgery for CBD in eight patients in 2001.…”

Variations of the hepatic artery and bile duct in patients with pancreaticobiliary maljunction: Impact on postoperative outcomes

“…Although the frequency of hepatic artery variation based on Hiatt's classification reportedly does not differ significantly between patients with CBD and the normal population, 2 it is important to understand the anatomy of the replaced or accessory right hepatic artery (rep/ac RHA), which arises from the superior mesenteric artery or aorta and ordinarily runs along the dilated bile duct 3 . Besides Hiatt's classification, the aberrant right hepatic artery (ARHA), which is defined as an artery running ventral to the common hepatic duct (CHD), is identified more frequently in patients with CBD than in the normal population 2–5 . When this variation is missing, and dissection is performed around the dilated bile duct, there is a risk of intraoperative injury and bleeding of the hepatic arteries 3 .…”

“…3 Besides Hiatt's classification, the aberrant right hepatic artery (ARHA), which is defined as an artery running ventral to the common hepatic duct (CHD), is identified more frequently in patients with CBD than in the normal population. [2][3][4][5] When this variation is missing, and dissection is performed around the dilated bile duct, there is a risk of intraoperative injury and bleeding of the hepatic arteries. 3 Moreover, the ARHA reportedly contribute to biliary stricture and hepatolithiasis in patients without CBD and postoperative anastomotic stenosis in those with CBD.…”