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Moynihan’s hump of the right hepatic artery in Calot’s triangle: a systematic review and meta-analysis of its incidence and surgical importance

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Abstract

Introduction

A rare variation known as “Moynihan’s or caterpillar hump” of the right hepatic artery raises the danger of vascular and biliary injuries during hepatobiliary surgery. This research intends to carefully record every case (i.e., patients undergoing laparoscopic cholecystectomy or cadaver dissections) where the right hepatic artery received a caterpillar hump.

Methods

The literature search was conducted with the medical subject headings (MeSH) and EMTREE (subject headings unique to Embase) keywords. The keywords with Boolean operators (OR, AND, and NOT) were used to create search strings in all possible combinations to retrieve bibliographic data. Two authors independently performed a risk of bias assessment and data extraction. The random effects model was used to conduct a meta-analysis.

Results

Thirty studies with a total of 8418 subjects reported that Moynihan's hump was present in 3.81% of them, with a predictive interval of 0.88–16.45%. The incidence of the hump was 3.1% in surgical studies (7496 subjects) and 7.22% (95% CI 4.7–10.93%) in cadaveric data (625 cadavers). Only ten studies addressed the relationship between the caterpillar hump and the common bile duct.

Conclusion

A patient with an unusually “small cystic artery” or “large right hepatic artery” is likely to have a “caterpillar hump”. The caterpillar’s hump of the right hepatic artery is subject to rare anatomical variations in its course that increase the risk of incorrect vessel ligation or injury during laparoscopic cholecystectomy.

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Data availability

All data are presented in the manuscript.

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Acknowledgements

The authors acknowledge the contribution of artists Mr. Chandan Kumar and Mr. Menajuddin Ansari for drawing and illustrations.

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Authors and Affiliations

  1. All India Institute of Medical Sciences, Patna, India

    Adil Asghar & Anil Kumar

  2. RIMS, Ranchi, India

    Ananya Priya

  3. All India Institute of Medical Sciences, Bathinda, India

    Apurba Patra

  4. JLN Hospital & Research Centre Bhilai, Bhilai, India

    Parag Gupta

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AA: project development, literature review, data analysis, manuscript writing. AP: Literature review, manuscript writing. AP: manuscript writing, manuscript editing. PG: manuscript editing and critical revision. AK: manuscript editing and critical revision. Approval of the final version of the manuscript: all authors.

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Correspondence to Apurba Patra.

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Asghar, A., Priya, A., Patra, A. et al. Moynihan’s hump of the right hepatic artery in Calot’s triangle: a systematic review and meta-analysis of its incidence and surgical importance. Surg Radiol Anat 45, 643–651 (2023). https://doi.org/10.1007/s00276-023-03125-8

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