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Journal List > J Korean Surg Soc > v.76(2) > 1010920

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Yang, Yin, Jang, Lee, Chung, Suh, Lee, and Kim: Establishment of a Guideline for the Safe Management of Anatomical Hepatic Artery Variations While Performing Major Hepato-pancreatico-biliary Surgery
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 76(2): 100-108.

Published online: 28 February 2009

DOI: https://doi.org/10.4174/jkss.2009.76.2.100

Establishment of a Guideline for the Safe Management of Anatomical Hepatic Artery Variations While Performing Major Hepato-pancreatico-biliary Surgery

Sung Hoon Yang, M.D., Ph.D., Yong Hu Yin, M.D.2, Jin-Young Jang, M.D., Ph.D.1, Seung Eun Lee, M.D.1, Jin Wook Chung, M.D., Ph.D.2, Kyung-Suk Suh, M.D., Ph.D.1, Kuhn Uk Lee, M.D., Ph.D.1, Sun-Whe Kim, M.D., Ph.D.1

Department of Surgery, Incheon Medical Center, Incheon, Korea.

1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

sunkim@plaza.snu.ac.kr

Received 13 October 2008       Accepted 3 November 2008

Copyright © 2009 The Korean Surgical Society

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.

Keywords: Hepatic artery, Anatomical variations, Hepato-pancreatico-biliary surgery

Figures and Tables

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Fig. 1
Some challenging variations of HA in performing hepato-pancreatico-biliary surgery in 1,324 cases (RHA = Right hepatic artery; LHA = Left hepatic artery; GDA = Gastroduodenal artery; SMA = Superior mesenteric artery; LGA = Left gastric artery; SpA = Splenic artery; S = Segment of liver according to Couinaud's classification).

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Fig. 2
Common hepatic artery arising from the superior mesenteric artery in 1,324 cases (*= Right gastroepiploic artery, †= Gastroduodenal artery).

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Fig. 3
Some challenging variations of the HA to 4 sections of the liver in performing the hepato-pancreatico-biliary surgery in 1,324 cases (RHA = Right hepatic artery; LHA = Left hepatic artery; RA = Right anterior hepatic artery; RP = Right posterior hepatic artery; LM = Left medial hepatic artery; LL = Left lateral hepatic artery; GDA = Gastroduodenal artery; SMA = Superior mesenteric artery; LGA = Left gastric artery; SpA = Splenic artery; S = Segment of liver according to Couinaud's classification).

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jkss-76-100-g004
Fig. 4
Algorithm for dealing with HA that has the problems of preservation in performing hepato-pancreatico-biliary surgery (HA = hepatic artery).

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Table 1
Summary of the challenging HA variations to be recognized while performing major hepatectomy or pancreatoduodenectomy
jkss-76-100-i001

*HA = Hepatic artery; †CHA = Common hepatic artery; ‡SMA = Superior mesenteric artery; §CA = Celiac axis; ∥RHA = Right hepatic artery; LHA = Left hepatic artery; **LGA = Left gastric artery; ††Double HA = RHA and LHA independently from the celiac axis. ‡‡GDA = Gastroduodenal artery; §§RGA = Right gastric artery; ∥∥LMHA = Left medial hepatic artery; ¶¶LLHA = Left lateral hepatic artery; ***RAHA = Right anterior hepatic artery; †††RPHA = Right posterior hepatic artery.

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