DOI: https://dx.doi.org/10.18203/2349-2902.isj20221163
Published: 2022-04-26

Right hepatic artery: primum discere anatomia-first, learn anatomy

Nakul Babanrao Aher, Ejaz Abdul Gafoor Thakur

Abstract


Laparoscopic cholecystectomy (LC) is the most commonly performed surgical procedure and considered as the gold standard treatment of gallstone disease. However, the overall rate of complications like injury to bile duct and hepatic artery in LC remains higher than that seen in open cholecystectomy. Hence complete knowledge of the anatomy and anatomical relationship of biliary tree and liver plays a key role in the laparoscopic hepatobiliary surgeries. Being an end artery, blood supply to the right lobe of the liver solely depends on the right hepatic artery. Identification of variations in hepatic arterial anatomy is important in the planning and performing of hepatobiliary surgeries varying from simple LC to pancreaticoduodenectomy. In the current study, the authors referenced laparoscopic dissection results to examine another rare case showing "anterior" relationship of aberrant right hepatic artery (ARHA) with the common hepatic duct having clinically important implications in LC. The objective of this study is to highlight the importance of learning anatomy as the first step for a successful surgery and with the help of this case contribute to existing knowledge of the right hepatic artery to improve surgical safety.


Keywords


LC, Hepatic artery variation, ARHA, Anterior relationship, Caterpillar hump, Calot's triangle

Full Text:

PDF

References


Csikesz NG, Singla A, Murphy MM. Surgeon volume metrics in laparoscopic cholecystectomy. Dig Dis Sci. 2010;55:2398.

Halasz NA. Cholecystectomy and hepatic artery injury. Arch Surg. 1991;126:137-8.

Chapman WC, Halevy A, Blumgart LH, Benjamin IS: Post-cholecystectomy bile duct strictures: management and outcome in 130 patients. Arch Surg. 1995;130:597-604.

Dandekar U, Dandekar K, Chavan S. Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance. Anatomy Res Int. 2015;412595:6.

Chen H, Yano R, Emura S, Shoumura S. Anatomic variation of the celiac trunk with special reference to hepatic artery patterns. Ann Anat. 2009;191(4):399-407.

Dolenšek J. Triple arterial blood supply to the liver and double cystic arteries. Folia Morphol (Warsz). 2017;76(3):523-6.

El Amrani M, Pruvot FR, Truant S. Management of the right hepatic artery in pancreaticoduodenectomy: a systematic review. J Gastrointest Oncol. 2016;7(2):298-305.

Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220(1):50-2.

Zaki SM, Abdelmaksoud AHK, Khaled BEA, Abdel Kader IA. Anatomical variations of hepatic artery using the multidetector computed tomography angiography. Folia Morphol (Warsz). 2020;79(2):247-54.

Abdalla S, Pierre S, Ellis H. Calot's triangle. Clin Anat. 2013;26(4):493‐501.

Strasberg SM. A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci. 2019;26(4):123-7.

Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010;211(1):132-8.

Alves A, Farges O, Nicolet J, Watrin T, Sauvanet A, Belghiti J. Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg. 2003;238:93-6.

Flint ER. Abnormalities of the right hepatic, cystic and gastro duodenal arteries and of bile ducts. Bri J Surg. 1923;10:509-19.

Bhargava GS, Singh H, Singh HD, Gupta R. Moynihan's hump of right hepatic artery: a case report and surgical significance. CIB Tech J Surg. 2014;3(2):42-4.

Devi J, Mugunthan N, Phalgunan V, Shiva DS. Caterpillar hump of right hepatic artery: incidence and surgical significance. National J Clin Anatomy. 2012;1(3):121-4.

Nagral S. Anatomy relevant to cholecystectomy. J Minimal Access Surg. 2005;1(2):53-8.

Mishal PL, Rajgopal L. Variant right hepatic artery forming Moynihan's hump-clinical relevance. Int J Anatomical Variations. 2010;3:144-5.

Jones RM, Hardy KJ. The hepatic artery: a reminder of surgical anatomy. J Royal College Surgeons of Edinburgh. 2001;46(3):168-70.

Bhardwaj N. Anomalous origins of hepatic artery and its significance for hepatobiliary surgery. J Anatomical Society of India. 2010;59(2):173-6.

Hollinshead WH. Anatomy for Surgeons; The Thorax Abdomen and Pelvis, Harper and Row, New York, NY, USA, 2nd edition. 1971.

Bergman RA, Afifi AK, Miyauchi R. Illustrated encyclopedia of human anatomic variations: Opus II: Cardiovascular system: Arteries: Abdomen: Variation in branch of celiac trunk: Hepatic artery. Accessed on: http://www.anatomyatlases.org/. Accessed on 10 Feb, 2021.

Flint ER. Abnormalities of the right hepatic, cystic and gastro duodenal arteries and of bile ducts. Bri J Surg. 1923;10:509-19.

Johnston EV, Anson BJ. Variations in the formation and vascular relationships of the bile ducts. Surg Gynecol Obstetr. 1952;94(6):669-86.