Establishment of a Guideline for the Safe Management of Anatomical Hepatic Artery Variations While Performing Major Hepato-pancreatico-biliary Surgery.
10.4174/jkss.2009.76.2.100
- Author:
Sung Hoon YANG
1
;
Yong Hu YIN
;
Jin Young JANG
;
Seung Eun LEE
;
Jin Wook CHUNG
;
Kyung Suk SUH
;
Kuhn Uk LEE
;
Sun Whe KIM
Author Information
1. Department of Surgery, Incheon Medical Center, Incheon, Korea.
- Publication Type:Original Article
- Keywords:
Hepatic artery;
Anatomical variations;
Hepato-pancreatico-biliary surgery
- MeSH:
Aorta;
Arteries;
Axis, Cervical Vertebra;
Hepatic Artery;
Mesenteric Artery, Superior
- From:Journal of the Korean Surgical Society
2009;76(2):100-108
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Hepato-pancreatico-biliary (HPB) surgeons often must make decisions regarding hepatic artery (HA) resection while performing major HPB surgery. The purpose of this report was to review and summarize HA resection experience with a focus on vascular preservation during major HPB surgery and to develop a useful algorithm in dealing with these needs. METHODS: We reviewed 1,324 cases that had available computed tomographic and angiographic findings and summarized the problematic HA variations encountered in major HPB surgery. In reviewing our series and previous studies, we have created a set of guidelines that enables a pragmatic approach to the unique variations in HA and the risks of cancer invasion. RESULTS: Challenging HA variations during major HPB surgery were found in 25.7% of the cases and included variations of common HA from superior mesenteric artery (SMA), gastroduodenal artery (GDA), aorta, celiaco-mesenteric (CM) trunk or left gastric artery (LGA) (3.70%), the variations of the right HA from SMA, GDA, aorta, celiac axis (CA) including CM trunk or LGA (12.76%), the variations of the left HA from LGA, CA or GDA (4.46%), and the mixed types of the aberrant left medial HA and/or left lateral HA and/or right anterior HA and/or right posterior HA (2.11%). CONCLUSION: Surgeons should have knowledge of the anatomically variable vasculature of the HA when planning for major HPB surgery. Preoperative imaging studies can aid and should be performed in anticipation of potential HA variations during major HPB surgery.
