Sithara Muthaniyil Samed, Prabuddha Jyoti Das, Akhila Mohan and Kavya Moonjelil Karthikeyan
Background: Pre-operative imaging and evaluation of living donors play a crucial role in the success of liver transplantation. Identification of variant vascular and biliary anatomy, in addition to planning surgical technique, aids in predicting the risk of surgical complications, subsequent biliary strictures, and liver abscesses. Good functioning of the graft depends on the intact arterial and portal blood supply as well as biliary and venous drainage from the liver segments. The purpose of this study was to determine the frequency with which surgically important hepatic vascular and biliary variants occur and their correlation with intraoperative findings.
Methods: This was a prospective observational study conducted over a period of 20 months involving 38 healthy liver donors between 18 and 60 years. A 128-slice MDCT scan was carried out to assess the arterial and portal anatomy. Arterial phases were taken after 20-30s, and portal phases approximately after 60-70 seconds. The delayed phase was taken following 90-100 seconds after the injection. To study the biliary anatomy, imaging was performed with 1.5 Tesla MRI T2-weighted images of 28 slices. Preoperative MRCP was assessed by a radiologist, not aware of the intra-operative findings. Intra-operative cholangiography was performed through a 4- or 5-F catheter inserted into the cystic duct while manually injecting 10 to 20 ml of iohexol.
Results: Comparing CT volumetry with post-hepatectomy volume, we found a mean deviation of 53.9±63.7 (17.8% discrepancy) in measurement of the right lobe. In the case of the left lobe, there was a mean deviation of 14.6±26.8 gms (18% discrepancy). Type I arterial anatomy was found in 71% of patients, type II arterial anatomy was found in 7.9%, type III anatomy in 13.2%, and 7.9% had type V arterial anatomy. Longer RHA hepatic artery was found in patients with type III arterial anatomy (replaced RHA from SMA). Shorter RHA was found in patients with type V arterial anatomy. The quadrate lobe is mainly supplied by the left hepatic artery. In a majority of the cases (55%), MHV and LHV join to form a common orifice before entering IVC, while RHV opened separately into IVC. One, two, or more accessory hepatic veins were seen in the majority of the cases. 81.6% had type I portal anatomy, and 13.2% had type II anatomy. Type III anatomy was found in 5.3% of patients, whereas in literature, type III anatomy was more common than type II.
Conclusion: Anatomical variants in the vascular and biliary systems are common in living liver donors and can pose challenges for the transplant. It\'s important to recognize and manage these variants to ensure the safety of the donor and reduce complications for the recipient.
Download PDF
View Abstract
No. of Downloads: 2 |
No. of Views: 1