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Aberrant left hepatic artery in laparoscopic antireflux procedures

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Abstract

Background

The aberrant left hepatic artery (ALHA) is an anatomic variation that may present an obstacle in laparoscopic antireflux procedures. Based on our experience, we addressed the following questions: How frequent is ALHA? When or why is it divided? What is the outcome in patients after division of the ALHA?

Methods

From a prospective collected database of 720 patients undergoing laparoscopic antireflux surgery, we collected the following information: presence of an ALHA, clinical data, diagnostic workup, operative reports, laboratory data, and follow-up data.

Results

In 57 patients (7.9%) (37 men and 20 women; mean age, 51 ± 15.7 years), an ALHA was reported. Hiatal dissection was impaired in 17 patients (29.8%), requiring division of the ALHA. In three patients (5.3%), the artery was injured during dissection; in one case (1.8%), it was divided because of ongoing bleeding. Ten of the divided ALHA (55.5%) were either of intermediate size or large. Mean operating time was 2.2 ± 0.8 h; mean blood loss was 63 ± 49 ml. Postoperative morbidity was 5.3% and mortality was 0%. None of the patients with divided hepatic arteries had postoperative symptoms related to impaired liver function. Postoperatively, two patients (11.7%) had transient elevated liver enzymes. At a mean follow-up of 28.5 ± 12.8 months, no specific complaints could be identified.

Conclusions

ALHA is not an uncommon finding in laparoscopic antireflux surgery and may be found in ≥8% of patients. Division may be required due to impaired view of the operating field or bleeding. Patients do not experience clinical complaints after division, but liver enzymes may be temporarily elevated.

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References

  1. VP Chuang S Wallace (1980) ArticleTitleHepatic arterial redistribution for intraarterial infusion of hepatic neoplasms. Radiology 135 295–299 Occurrence Handle1:STN:280:Bi%2BC28joslw%3D Occurrence Handle7367615

    CAS  PubMed  Google Scholar 

  2. JM Daly N Kemeny P Oderman J Botet (1984) ArticleTitleLong-term hepatic arterial infusion chemotherapy: anatomic considerations, operative technique, and treatment morbidity. Arch Surg 119 936–941 Occurrence Handle1:STN:280:BiuB2MngsFM%3D Occurrence Handle6378147

    CAS  PubMed  Google Scholar 

  3. JK Edoga CL Willekes (1997) ArticleTitleLaparoscopic fundoplication and the aberrant left hepatic artery. Arch Surg 132 448–449 Occurrence Handle1:STN:280:ByiB283kvVI%3D Occurrence Handle9108770

    CAS  PubMed  Google Scholar 

  4. RJ Finley RI Inculet (1989) ArticleTitleThe results of esophagogastrectomy without thoracotomy for adenocarcinoma of the esophagogastric junction. Ann Surg 210 535–542 Occurrence Handle1:STN:280:By%2BD38rkvVc%3D Occurrence Handle2478086

    CAS  PubMed  Google Scholar 

  5. SR Friesen (1957) ArticleTitleThe significance of the anomalous origin of the left hepatic artery from the left gastric artery in operation upon the stomach or esophagus. Am Surg 23 1103–1108 Occurrence Handle1:STN:280:CyeD3s%2Fnt1Y%3D Occurrence Handle13488026

    CAS  PubMed  Google Scholar 

  6. JE Healey PC Schroy RJ Sorensen (1953) ArticleTitleThe intrahepatic distribution of the hepatic artery in man. J Int Coll Surg 20 133 Occurrence Handle13084954

    PubMed  Google Scholar 

  7. AW Hemming RJ Finley KG Evans B Nelems G Fradet (1992) ArticleTitleEsophagogastrectomy and the variant left hepatic artery. Ann Thorac Surg 54 166–168 Occurrence Handle1:STN:280:By2A3cvht1E%3D Occurrence Handle1610235

    CAS  PubMed  Google Scholar 

  8. RA Hinder CJ Filipi (1992) ArticleTitleThe technique of laparoscopic Nissen fundoplication. Surg Laparosc Endosc 2 265–272 Occurrence Handle1:STN:280:ByuD1c%2FlsFA%3D Occurrence Handle1341544

    CAS  PubMed  Google Scholar 

  9. RA Hinder CJ Filipi G Wetscher P Neary et al. (1994) ArticleTitleLaparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 220 472–481 Occurrence Handle1:STN:280:ByqD3s7jsVI%3D Occurrence Handle7944659

    CAS  PubMed  Google Scholar 

  10. RE Koehler M Korobkin F Lewis (1975) ArticleTitleArteriographic demonstration of collateral arterial supply to the liver after hepatic artery ligation. Radiology 117 49–54 Occurrence Handle1:STN:280:CSmD3M3ntlM%3D Occurrence Handle1162072

    CAS  PubMed  Google Scholar 

  11. AS Lurie (1987) ArticleTitleThe significance of the variant left accessory hepatic artery in surgery for proximal gastric cancer. Arch Surg 122 725–728 Occurrence Handle1:STN:280:BiiB3M3lt1I%3D Occurrence Handle3579588

    CAS  PubMed  Google Scholar 

  12. NA Michels (1966) ArticleTitleNewer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112 337–347 Occurrence Handle1:STN:280:CCiD3MznvVQ%3D Occurrence Handle5917302

    CAS  PubMed  Google Scholar 

  13. S Okano K Sawai H Taniguchi T Takahashi (1993) ArticleTitleAberrant left hepatic artery arising from the left gastric artery and liver function after radical gastrectomy for gastric cancer. World J Surg 17 70–74 Occurrence Handle1:STN:280:ByyC1M%2FlslA%3D Occurrence Handle8447143

    CAS  PubMed  Google Scholar 

  14. B Reimann W Lierse HW Schreiber (1983) ArticleTitleAnastomoses between the segmental arteries of the liver and phrenicohepatic arterio-arterial anastomoses. Langenbecks Arch Chir 359 81–92 Occurrence Handle1:STN:280:BiyC2c%2Fkt1w%3D Occurrence Handle6827883

    CAS  PubMed  Google Scholar 

  15. GH Rong WF Sindelar (1987) ArticleTitleAberrant peripancreatic arterial anatomy: considerations in performing pancreatectomy for malignant neoplasms. Am Surg 53 726–729 Occurrence Handle1:STN:280:BieC3cvpt1Y%3D Occurrence Handle3425998

    CAS  PubMed  Google Scholar 

  16. LJ Skandalakis GL Colborn SW Gray JE Skandalakis (1992) Surgical anatomy of the liver and extrahepatic biliary tract. LM Nyhus RJ Baker (Eds) Mastery of surgery Vol 1 EditionNumber2nd ed Little, Brown Boston 775–805

    Google Scholar 

  17. T Suzuki A Nakayasu K Kawabe H Takeda I Honjo (1971) ArticleTitleSurgical significance of anatomic variations of the hepatic artery. Am J Surg 122 505–512 Occurrence Handle1:STN:280:CS2D3M3ns1Q%3D Occurrence Handle5098656

    CAS  PubMed  Google Scholar 

  18. T Takayama M Makuuchi H Kawarasaki Y Harihara et al. (1997) ArticleTitleHepatic transplantation using living donors with aberrant hepatic artery. J Am Coll Surg 184 525–528 Occurrence Handle1:STN:280:ByiB1M%2Fkt1Q%3D Occurrence Handle9145077

    CAS  PubMed  Google Scholar 

  19. JP Vandamme J Bonte G Schueren ParticleVan der (1969) ArticleTitleA revaluation of hepatic and cystic arteries: The importance of the aberrant hepatic branches. Acta Anat (Basel) 73 192–209 Occurrence Handle1:STN:280:CS%2BD3cbhs1w%3D

    CAS  Google Scholar 

  20. RH Wachsberg KC Cho S Raina (1994) ArticleTitleLiver infarction following unrecognized right hepatic artery ligation at laparoscopic cholecystectomy. Abdom Imag 19 53–54 Occurrence Handle1:STN:280:ByuB3MvjtV0%3D

    CAS  Google Scholar 

  21. A Weimann HJ Meyer S Mauz B Ringe et al. (1991) ArticleTitleAnatomic variations in the course of the left hepatic artery: a problem for systematic lymphadenectomy in gastrectomy or proximal stomach resection before stomach tube formation. Chirurg 62 552–556 Occurrence Handle1:STN:280:By2D3snntlY%3D Occurrence Handle1935382

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA

    P. J. Klingler, M. H. Seelig, N. R. Floch, S. A. Branton, M. C. Freund & R. A. Hinder

  2. Department of Radiology, University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria

    N. Katada

Authors
  1. P. J. Klingler
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  2. M. H. Seelig
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  3. N. R. Floch
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  4. S. A. Branton
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  5. M. C. Freund
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  6. N. Katada
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  7. R. A. Hinder
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Klingler, P.J., Seelig, M.H., Floch, N.R. et al. Aberrant left hepatic artery in laparoscopic antireflux procedures. Surg Endosc 18, 807–811 (2004). https://doi.org/10.1007/s00464-003-8280-0

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  • DOI: https://doi.org/10.1007/s00464-003-8280-0

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