Clinical significance of anatomical variation of bile duct and hepatic artery at hepatic hilus for biliary surgery

Abstract

It is well known that there are many anatomical variations in bile duct and hepatic artery at hepatic hilus. Preoperative anatomical evaluation of the branching pattern and running course of the bile duct and hepatic artery in relation to the portal vein is not only crucial for safe biliary surgery, but also important for achieving R0 resection, especially for perihilar cholangiocarcinoma (PHC). Clinical significance of infraportal running course of the right posterior sectional bile duct and supraportal running course of the right posterior hepatic artery has been well recognized in PHC surgery. However, there is other several anatomical variations that have a possibility of affecting curability and/or causing serious postoperative complication, even if that variant is extremely rare. With recent technical advances in diagnostic imaging, the detailed three-dimensional (3D) anatomy at hepatic hilus can be easily evaluated with a workstation using 3D image analysis software. Herein, anatomical variations of bile duct and hepatic artery that biliary surgeon should recognize before surgery are demonstrated in comparison to the standard 3D surgical anatomy, and clinical significance of these variations is discussed.