Variations in the Origin and Course of Right Hepatic Artery and its Surgical Significance AC01-AC04
Dr. Narayanaperumal Mugunthan,
Associate Professor, Department of Anatomy, Mahatma Gandhi Medical College & Research Institute,
Pillaiyarkuppam, Puducherry, Pincode -607402, India.
Introduction: Variations in the Right Hepatic Artery (RHA) are exceedingly common and these variations are of great importance to surgeons and interventional radiologists. A thorough knowledge of the right hepatic arterial anatomy is mandatory while performing hepatic surgery and hepatic arteriography.
Aim: To find out the variations in the origin and course of the RHA and its surgical significance.
Materials and Methods: This study was conducted in 60 embalmed adult cadavers of both sexes of age group between 50 to 80 years. Abdomen was opened by a linear midline incision extending from the xiphoid process to the pubic symphysis. The origin of RHA from the proper hepatic artery was traced. The presence of aberrant right hepatic arteries -replaced and accessory were noted. The source of origin of accessory or replaced RHA arising from the superior mesenteric artery (SMA), right renal artery and inferior mesenteric artery was traced. The course of normal and aberrant RHA from its origin to the entrance into the right lobe of the liver was followed and structures related to it were noted.
Results: The RHA mostly originated from the main trunk of the proper hepatic artery in 52 specimens (86.6%). Presence of aberrant RHA was found in 8 specimens (13.3%). Among 8 specimens of aberrant RHA, replaced RHA arising from SMA was found in 5 specimens (8.3%) and accessory RHA arising from SMA was observed in 3 specimens (5%). In 86.6% of specimens, the RHA coursed dorsal to the duct system to enter the Calots triangle. In 8.3% of specimens, the RHA coursed ventral to duct system to reach the Calots triangle. The caterpillar like loop of the RHA was found in two specimens (3%). The replaced and accessory RHA (13.3%) arising from the SMA had a course dorsal to duct system to reach the Calots triangle.
Conclusion: Right hepatic artery is subject to anatomical variation in its origin and course. Our study identified the variations in the origin and course of right hepatic artery. Adequate knowledge of these variations would be of incredible help to the hepatobiliary surgeon and interventional radiologist.