open access

Vol 82, No 3 (2023)
Original article
Submitted: 2022-01-04
Accepted: 2022-04-07
Published online: 2022-04-28
Get Citation

Unravelling the mystery of porta hepatis for surgical benefit

A. Saha1, P. Srimani2
·
Pubmed: 35607875
·
Folia Morphol 2023;82(3):580-586.
Affiliations
  1. Department of Anatomy, R.G. Kar Medical College, Kolkata, West Bengal, India
  2. Department of Anatomy, Calcutta National Medical College, Kolkata, West Bengal, India

open access

Vol 82, No 3 (2023)
ORIGINAL ARTICLES
Submitted: 2022-01-04
Accepted: 2022-04-07
Published online: 2022-04-28

Abstract

Background: Hepatobilliary surgery is nowadays growing with increasing popularity
throughout the world with advent of newer liver imaging modalities.
Anticipating a wide range of morphological variations of porta hepatis (PH),
a precise understanding is pertinent to preoperative diagnosis, operative procedure
and post-operative outcome of hepatobiliary disease.
Materials and methods: Considering recent interest, present study was undertaken.
One-hundred and ten isolated adult cadaveric livers of unknown age and
sex were dissected to explore detail morphology and morphometry of PH.
Results: Classical picture of PH was observed in 20% liver. The standard representation
of structures was highest in hepatic artery (59.1%) followed by portal vein
(55.5%) and hepatic duct (51.8%). On the basis of structural distribution PH was
described as 16 types. Maximum variable number was found in hepatic artery
followed by portal vein and hepatic duct. In morphometric analysis, transverse
diameter of PH was more than antero-posterior diameter, indicated that PH was
slightly oval in transverse plane. Position of PH was more towards posterior and
slightly right in inferior surface of liver.
Conclusions: Variations of portal anatomy regarding circulatory and biliary dynamics
is worth knowing in successful planning of hepatobiliary surgeries with
least complications.

Abstract

Background: Hepatobilliary surgery is nowadays growing with increasing popularity
throughout the world with advent of newer liver imaging modalities.
Anticipating a wide range of morphological variations of porta hepatis (PH),
a precise understanding is pertinent to preoperative diagnosis, operative procedure
and post-operative outcome of hepatobiliary disease.
Materials and methods: Considering recent interest, present study was undertaken.
One-hundred and ten isolated adult cadaveric livers of unknown age and
sex were dissected to explore detail morphology and morphometry of PH.
Results: Classical picture of PH was observed in 20% liver. The standard representation
of structures was highest in hepatic artery (59.1%) followed by portal vein
(55.5%) and hepatic duct (51.8%). On the basis of structural distribution PH was
described as 16 types. Maximum variable number was found in hepatic artery
followed by portal vein and hepatic duct. In morphometric analysis, transverse
diameter of PH was more than antero-posterior diameter, indicated that PH was
slightly oval in transverse plane. Position of PH was more towards posterior and
slightly right in inferior surface of liver.
Conclusions: Variations of portal anatomy regarding circulatory and biliary dynamics
is worth knowing in successful planning of hepatobiliary surgeries with
least complications.

Get Citation

Keywords

liver, porta hepatis, variation, morphology, morphometry

About this article
Title

Unravelling the mystery of porta hepatis for surgical benefit

Journal

Folia Morphologica

Issue

Vol 82, No 3 (2023)

Article type

Original article

Pages

580-586

Published online

2022-04-28

Page views

961

Article views/downloads

651

DOI

10.5603/FM.a2022.0047

Pubmed

35607875

Bibliographic record

Folia Morphol 2023;82(3):580-586.

Keywords

liver
porta hepatis
variation
morphology
morphometry

Authors

A. Saha
P. Srimani

References (27)
  1. Aydin N, Sardi A, Milovanov V. Approach to the porta hepatis during cytoreductive surgery: technical considerations. Ann Surg Oncol. 2016; 23(2): 552–555.
  2. Caiado AH, Blasbalg R, Marcelino AS, et al. Complications of liver transplantation: multimodality imaging approach. Radiographics. 2007; 27(5): 1401–1417.
  3. Catalano OA, Singh AH, Uppot RN, et al. Vascular and biliary variants in the liver: implications for liver surgery. Radiographics. 2008; 28(2): 359–378.
  4. Chaib E. Absence of bifurcation of the portal vein. Surg Radiol Anat. 2009; 31(5): 389–392.
  5. Covey AM, Brody LA, Getrajdman GI, et al. Incidence, patterns, and clinical relevance of variant portal vein anatomy. Am J Roentgenol. 2004; 183(4): 1055–1064.
  6. Devi KP. The study of variations of extra-hepatic biliary apparatus. IOSR J Dental Med Sci. 2013; 5(5): 25–31.
  7. Duffy JP, Hong JC, Farmer DG, et al. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg. 2009; 208(5): 896–903; discussion 903.
  8. Düşünceli E, Erden A, Erden I. [Anatomic variations of the bile ducts: MRCP findings]. Tani Girisim Radyol. 2004; 10(4): 296–303.
  9. Erbay N, Raptopoulos V, Pomfret EA, et al. Living donor liver transplantation in adults: vascular variants important in surgical planning for donors and recipients. Am J Roentgenol. 2003; 181(1): 109–114.
  10. Fasel JH, Muster M, Gailloud P, et al. Duplicated hepatic artery: radiologic and surgical implications. Acta Anat (Basel). 1996; 157(2): 164–168.
  11. Garg S, Kumar K, Sahni D, et al. Surgical anatomy of the vasculobiliary apparatus at the hepatic hilum as applied to liver transplantations and major liver resections. J Anat Soc India. 2018; 67(1): 61–69.
  12. Gupta D, Sharma P, Gandotra A. Porta hepatis in normal liver. Int J Biomed Adv Res. 2017; 8(3): 121–125.
  13. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994; 220(1): 50–52.
  14. Koç Z, Oğuzkurt L, Ulusan S. Portal vein variations: clinical implications and frequencies in routine abdominal multidetector CT. Diagn Interv Radiol. 2007; 13(2): 75–80.
  15. Kostov DV, Kobakov GL. Six rare biliary tract anatomic variations: implications for liver surgery. Eurasian J Med. 2011; 43(2): 67–72.
  16. Madoff DC, Hicks ME, Vauthey JN, et al. Transhepatic portal vein embolization: anatomy, indications, and technical considerations. Radiographics. 2002; 22(5): 1063–1076.
  17. McSweeney SE, Kim TK, Jang HJ, et al. Biliary anatomy in potential right hepatic lobe living donor liver transplantation (LDLT): the utility of CT cholangiography in the setting of inconclusive MRCP. Eur J Radiol. 2012; 81(1): 6–12.
  18. Mortelé KJ, Cantisani V, Troisi R, et al. Preoperative liver donor evaluation: Imaging and pitfalls. Liver Transpl. 2003; 9(9): S6–14.
  19. Mortelé KJ, Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications. Am J Roentgenol. 2001; 177(2): 389–394.
  20. Neginhal DD, Kulkarni UK. Normal anatomy of porta hepatis: a cadaveric study. Nat J Clin Anat. 2019; 8(1): 22.
  21. Ohkubo M, Nagino M, Kamiya J, et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg. 2004; 239(1): 82–86.
  22. Redman HC, Reuter SR. Angiographic demonstration of surgically important vascular variations. Surg Gynecol Obstet. 1969; 129(1): 33–39.
  23. Sapna M, Shetty SD, Nayak S. A study on the number and arrangement of the structures passing through the porta hepatis in south indian population. Int J Morphol. 2015; 33(1): 164–168.
  24. Seco M, Donato P, Costa J, et al. Vascular liver anatomy and main variants: what the radiologist must know. JBR-BTR. 2010; 93(4): 215–223.
  25. Sheldon GF, Lim RC, Yee ES, et al. Management of injuries to the porta hepatis. Ann Surg. 1985; 202(5): 539–545.
  26. Suzuki T, Nakayasu A, Kawabe K, et al. Surgical significance of anatomic variations of the hepatic artery. Am J Surg. 1971; 122(4): 505–512.
  27. van den Hoven AF, Smits MLJ, de Keizer B, et al. Identifying aberrant hepatic arteries prior to intra-arterial radioembolization. Cardiovasc Intervent Radiol. 2014; 37(6): 1482–1493.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl