Identification and management of hepatic artery variation in laparoscopic panc<b>-</b>reaticoduodenectomy: a report of 9 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FU Qihan , CHEN Pingping , ZENG Yongchao , TANG Rong , ZHANG Jiachao , LI Qijin , QIAO Xin ,  ZHANG Zhensheng

Department of Hepatobiliary and Pancreatic Surgery, Hainan Provincial People’s Hospital, Haikou 570311, P. R. China;

Corresponding?author：

ZHANG Zhensheng, Email: 13876085818@163.com

Keywords：

laparoscopic pancreaticoduodenectomy; hepatic artery variation; typing

DOI：

10.7507/1007-9424.202304042

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the hepatic artery variations encountered in laparoscopic pancreaticoduodenectomy (LPD) surgery and its significance. Methods The clinical datas of 26 patients who underwent LPD from January 2020 to January 2023 were retrospectively collected. Preoperative evaluation of hepatic artery variability and its types based on relevant clinical and imaging data, as well as targeted measures taken during surgery, and patients’ prognosis were analyzed. Results According to preoperative abdominal enhanced CT, arterial computer tomography angiography imaging and intraoperative skeletonization of the hepatoduodenal ligament, hepatic artery variation was found in 9 of 26 patients undergoing LPD. The left hepatic artery was substituted in 1 case, the right hepatic artery was substituted in 2 cases, 2 cases were the left accessory hepatic artery, and the common hepatic artery originated from the superior mesenteric artery in 3 cases. There was 1 case, right hepatic artery coming from the abdominal aorta, whose arterial variation was not included in the traditional typing. The variant hepatic artery from superior mesenteric artery was separated by posterior approach during operation, and the variant hepatic artery from left gastric artery was separated by anterior approach during operation. Nine patients with hepatic artery variation recovered well after operation, and no serious complications occurred. Conclusions Various hepatic artery variations during LPD need to be carefully evaluated before surgery. During surgery, it should be determined whether to retain the mutated blood vessel based on its diameter and changes in liver blood flow after occlusion, so that reasonable operation can be performed during the operation to avoid hepatic artery damage.

Citation： FU Qihan, CHEN Pingping, ZENG Yongchao, TANG Rong, ZHANG Jiachao, LI Qijin, QIAO Xin, ZHANG Zhensheng. Identification and management of hepatic artery variation in laparoscopic panc-reaticoduodenectomy: a report of 9 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(9): 1037-1041. doi: 10.7507/1007-9424.202304042 Copy

1.	李佳, 彭創, 厲鷗, 等. 腹腔鏡胰十二指腸切除圍手術期動脈變異的處理策略. 中華肝膽外科雜志, 2018, 24(12): 838-842.
2.	王健, 謝敏, 包善華. 胰十二指腸切除術中肝動脈變異及意義. 中華胰腺病雜志, 2009, 9(4): 226-228.
3.	裘法祖, 王健本, 張祜曾. 腹部外科臨床解剖學. 濟南: 山東科學技術出版社, 2001: 138-146.
4.	Kaneko J, Ichida A, Kawaguchi Y, et al. Pancreaticoduodenectomy: how to handle a replaced right hepatic artery. Hepatobiliary Surg Nutr 2023, 12(2): 280-283.
5.	Malviya KK, Verma A. Importance of anatomical variation of the hepatic artery for complicated liver and pancreatic surgeries: A review emphasizing origin and branching. Diagnostics (Basel), 2023, 13(7): 1233.
6.	盧川, 劉作勤, 劉林祥, 等. 肝動脈解剖變異的DSA研究. 中國臨床解剖學雜志, 2007, 25(4): 389-393.
7.	Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg, 1966, 112(3): 337-347.
8.	Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases. Ann Surg, 1994, 220(1): 50-52.
9.	曾維, 顏杰, 等. 腹部CTA對肝動脈變異新分型的解剖學研究. 局解手術學雜志, 2022, 31(11): 937-942.
10.	袁晶, 陳蓉, 羅香國, 等. 肝動脈解剖變異的DSA與CTA對比分析. 重慶醫學, 2009, 38(23): 2973-2974, 2977.
11.	Xu YC, Yang F, Fu DL. Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review. World J Gastroenterol, 2022, 28(19): 2057-2075.
12.	朱欣, 魯葆春, 陳志良, 等. 腹腔鏡胰十二指腸切除術患者肝動脈變異的識別與處理. 中華普通外科雜志, 2022, 37(1): 49-50.
13.	李家開, 張金山. 迷走肝動脈的DSA研究及臨床意義. 臨床放射學雜志, 2002, 21(3): 230-235.
14.	Pyras C, Lukas C, Janot-Matuschek M, et al. Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy—own results and a systematic review of the literature. Hepatobiliary Surg Nutr, 2022, 11(1): 25-37.
15.	Giani A, Mazzola M, Morini L, et al. Hepatic vascular anomalies during totally laparoscopic pancreaticoduodenectomy: challenging the challenge. Updates Surg, 2022, 74(2): 583-590.

1. 李佳, 彭創, 厲鷗, 等. 腹腔鏡胰十二指腸切除圍手術期動脈變異的處理策略. 中華肝膽外科雜志, 2018, 24(12): 838-842.
2. 王健, 謝敏, 包善華. 胰十二指腸切除術中肝動脈變異及意義. 中華胰腺病雜志, 2009, 9(4): 226-228.
3. 裘法祖, 王健本, 張祜曾. 腹部外科臨床解剖學. 濟南: 山東科學技術出版社, 2001: 138-146.
4. Kaneko J, Ichida A, Kawaguchi Y, et al. Pancreaticoduodenectomy: how to handle a replaced right hepatic artery. Hepatobiliary Surg Nutr 2023, 12(2): 280-283.
5. Malviya KK, Verma A. Importance of anatomical variation of the hepatic artery for complicated liver and pancreatic surgeries: A review emphasizing origin and branching. Diagnostics (Basel), 2023, 13(7): 1233.
6. 盧川, 劉作勤, 劉林祥, 等. 肝動脈解剖變異的DSA研究. 中國臨床解剖學雜志, 2007, 25(4): 389-393.
7. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg, 1966, 112(3): 337-347.
8. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases. Ann Surg, 1994, 220(1): 50-52.
9. 曾維, 顏杰, 等. 腹部CTA對肝動脈變異新分型的解剖學研究. 局解手術學雜志, 2022, 31(11): 937-942.
10. 袁晶, 陳蓉, 羅香國, 等. 肝動脈解剖變異的DSA與CTA對比分析. 重慶醫學, 2009, 38(23): 2973-2974, 2977.
11. Xu YC, Yang F, Fu DL. Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review. World J Gastroenterol, 2022, 28(19): 2057-2075.
12. 朱欣, 魯葆春, 陳志良, 等. 腹腔鏡胰十二指腸切除術患者肝動脈變異的識別與處理. 中華普通外科雜志, 2022, 37(1): 49-50.
13. 李家開, 張金山. 迷走肝動脈的DSA研究及臨床意義. 臨床放射學雜志, 2002, 21(3): 230-235.
14. Pyras C, Lukas C, Janot-Matuschek M, et al. Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy—own results and a systematic review of the literature. Hepatobiliary Surg Nutr, 2022, 11(1): 25-37.
15. Giani A, Mazzola M, Morini L, et al. Hepatic vascular anomalies during totally laparoscopic pancreaticoduodenectomy: challenging the challenge. Updates Surg, 2022, 74(2): 583-590.

Previous Article
The progress and major challenges of immunotherapy for pancreatic cancer
Next Article
Feasibility and safety of laparoscopic Frey’s procedure for chronic pancreatitis

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Identification and management of hepatic artery variation in laparoscopic panc-reaticoduodenectomy: a report of 9 cases

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content