An aberrant hepatic artery originating from the gastroduodenal artery could be problematic during pancreatoduodenectomy

Abstract

Anatomical variations in the hepatic artery are frequently encountered in pancreatoduodenectomy (PD). These variations include an aberrant hepatic artery (AHA), which was found in 35% of cases in a study of 172 patients who underwent PD. Within this group, 2.3% of patients had a specific type of AHA, called the aberrant right hepatic artery (ARHA), which arises from the gastroduodenal artery (GDA). This type of AHA is particularly challenging to deal with during PD because it can be accidentally damaged when the GDA is ligated. Previous reports have shown the incidence of this variation to be 0.28% to 2.0%. To prevent complications during PD, such as liver abscess, bile duct stenosis, and bilioenteric anastomotic leakage, it is critical to preserve the AHA. To achieve this, preoperative imaging techniques, such as enhance-contrasted CT with three-dimensional reconstruction, can help identify the relationship between the tumor and HA anatomy. Additionally, an intraoperative clamp test of GDA before resection may be useful in preventing ARHA injury.