Abstract
Certain anatomical variations may represent preconditions for technical operation errors in right trisectionectomy. These variations include: the confluence of the common bile duct, the length of the left hepatic duct, the localization of the bile duct confluence for segments 2 and 3 of the umbilical portion of the left portal vein and the peculiarities of the afferent and efferent blood supply of these two segments. The aim of the present study is to identify and discuss such preconditions. The anatomical variations of the common bile duct confluence were analyzed by intraoperative cholangiography in 112 patients undergoing liver resections and in 32 preparations after left hepatectomy. The variations of the afferent and efferent blood supply were morphologically examined in 43 liver resections. Seven types of anatomical variations of the common bile duct confluence were detected through intraoperative cholangiography, and three were extracted from the available literature. Three anatomical types (central, peripheral, and combined) of bile drainage from segment 4 were established. The mean distance between the bile duct confluence for segments 2 and 3 and the main hepatic duct confluence, i. e., the length of the left hepatic duct, was 3.68 cm. The anatomical peculiarities of the afferent and efferent arterial and venous supply of segments 2 and 3 were presented and discussed with respect to their roles in a safe right trisectionectomy. Surgeons' sound knowledge of anatomical variations of the biliary tract and hepatic blood vessels coupled with increased experience and technique refinements could contribute to better outcomes in right trisectionectomy.
Highlights
The anatomical variations of the common bile duct confluence were analyzed by intraoperative cholangiography in 112 patients undergoing liver resections and in 32 preparations after left hepatectomy
Seven types of anatomical variations of the common bile duct confluence were detected through intraoperative cholangiography, and three were extracted from the available literature
Surgeons’ sound knowledge of anatomical variations of the biliary tract and hepatic blood vessels coupled with increased experience and technique refinements could contribute to better outcomes in right trisectionectomy
Summary
The anatomical variations of the common bile duct confluence were analyzed by intraoperative cholangiography in 112 patients undergoing liver resections and in 32 preparations after left hepatectomy. The surgical anatomy of the afferent and efferent blood supply was examined while conducting 43 liver resections, including 9 segmentectomies of Sg4; 13 bisegmentectomies of Sg2, 3; 17 central hepatic resections and 4 right trisectionectomies as well as during the section of 32 preparations after left hepatectomy With these 32 preparations, parenchymal transection at the border between the left medial and lateral sections enabled the exact localization of the bile duct confluence for Sg2, 3 as compared to the LPV umbilical portion, an important landmark during right trisectionectomy. Transection at the border between the left medial and lateral sections after left hepatectomy was used to purposefully search for an independent drainage of Sg2 or Sg3 into the VHM
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