ANATOMIC DISSOCIATION BETWEEN THE INTRAHEPATIC BILE-DUCT AND PORTAL-VEIN - RISK-FACTORS FOR LEFT HEPATECTOMY

Citation
Yf. Cheng et al., ANATOMIC DISSOCIATION BETWEEN THE INTRAHEPATIC BILE-DUCT AND PORTAL-VEIN - RISK-FACTORS FOR LEFT HEPATECTOMY, World journal of surgery, 21(3), 1997, pp. 297-300
Citations number
15
Categorie Soggetti
Surgery
Journal title
ISSN journal
03642313
Volume
21
Issue
3
Year of publication
1997
Pages
297 - 300
Database
ISI
SICI code
0364-2313(1997)21:3<297:ADBTIB>2.0.ZU;2-H
Abstract
The anatomic variations of the intrahepatic portal vein and bile duct were analyzed to evaluate the potential risk of left hepatectomy. A to tal of 210 cholangiograms and hepatic arterioportograms were performed in which the ramifications of the intrahepatic portal vein and bile d uct were investigated. The orientation of the intrahepatic duct and po rtal vein were classified into five types. In 175 patients (83.33%), t he intrahepatic portal vein and bile duct had the same anatomic classi fication. In 24 patients (11.43%), the right anterior or posterior int rahepatic duct drained into the left hepatic duct at the umbilical por tion (type TV); there were only 15 patients (7.14%) :whose portal vein s fell into this category. All patients with type IV portal veins had type IV hepatic ducts, but there were 9/49 patients (18.36%) whose hep atic duct distribution belonged to type IV but their portal veins belo nged to type II (6 cases) or III (3 cases). Without complete knowledge of the intrahepatic portal anti biliary anatomy, insufficient portal perfusion and bile duct complications may result from the left hepatec tomy operation. Preoperative portal vein evaluation or left portal vei n clamping can provide significant information, but there are still 18 .36% of patients where type IV biliary ducts were? not detected in tho se with type II and III portal veins. Cholangiography is of paramount importance in these two groups of patients, as it can prevent inadvert ent injury to the right intrahepatic ducts, which drain into the left intrahepatic duct. On the other hand, intraoperative ultrasonography i s recommended to identify or exclude an aberrant portal vein if type V I biliary anatomy is detected during intraoperative cholangiography.