Aberrant left hepatic artery in laparoscopic gastric banding

Background: The aberrant left hepatic artery (ALHA) is an anatomic Variatio n which may be an obstacle in the laparoscopic gastric banding operation. B ased on our experience, our mission was to answer the questions: How freque ntly is an ALHA encountered? is division necessary? Are there any additiona l complications in cases where the ALHA is preserved? Methods: In a prospectively collected database of 270 patients undergoing l aparoscopic gastric banding in our unit, information including presence of an ALHA, clinical data, diagnostic work-up, operative reports, laboratory d ata, and follow-up data were collected. Results: In 48 patients (17.7%) (39 women, 9 men, mean age 39.2 years) an A LHA was observed. Hiatal dissection was not impaired in any of these patien ts, and none required division of the ALHA. In all but two cases, the band was placed above the ALHA, offering additional stability to the band positi oning. In 2 patients (4.1%), the artery was injured during dissection and w as divided due to ongoing bleeding. Twenty-two (45.8%) of the ALHAs were of intermediate or large size. Neither pouch dilatation nor band slippage occ urred in the above-mentioned group. The two patients with divided hepatic a rteries had no postoperative symptoms related to impaired liver function. Conclusions: ALHA is not an uncommon finding during laparoscopic gastric ba nding and may be found in approximately 18% of patients. Division can nearl y always be avoided and may be required only in selected cases due to bleed ing. Patients do not experience clinical complications after division, alth ough liver enzymes may be temporarily elevated, and no monitoring is necess ary.