Brief Article
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World J Gastrointest Surg. Jan 27, 2014; 6(1): 9-13
Published online Jan 27, 2014. doi: 10.4240/wjgs.v6.i1.9
Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy
Ashwin Rammohan, Ravichandran Palaniappan, Anbalagan Pitchaimuthu, Kamalakannan Rajendran, Senthil Kumar Perumal, Kesavan Balaraman, Ravi Ramasamy, Jeswanth Sathyanesan, Manoharan Govindan
Ashwin Rammohan, Ravichandran Palaniappan, Anbalagan Pitchaimuthu, Kamalakannan Rajendran, Senthil Kumar Perumal, Kesavan Balaraman, Ravi Ramasamy, Jeswanth Sathyanesan, Manoharan Govindan, The Institute of Surgical Gastroenterology and Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Stanley Medical College Hospital, Chennai 600 001, India
Author contributions: Rammohan A, Palaniappan R, Pitchaimuthu A, Rajendran K and Perumal SK contributed to the conception and design, acquisition, analysis and interpretation of data; Rammohan A, Balaraman K, Ramasamy R and Sathyanesan J drafted the article and revised it critically for important intellectual content; Sathyanesan J, Palaniappan R and Govindan M gave the final approval of the version to be published.
Correspondence to: Dr. Ashwin Rammohan, The Institute of Surgical Gastroenterology and Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600 001, India. ashwinrammohan@gmail.com
Telephone: +91-988-4173583 Fax: +91-44-25289595
Received: October 14, 2013
Revised: December 7, 2013
Accepted: December 17, 2013
Published online: January 27, 2014
Processing time: 105 Days and 15.9 Hours
Abstract

AIM: To analyze the differences in outcomes and the clinical impact following pancreatoduodenectomy (PD) in patients with and without aberrant right hepatic artery (aRHA).

METHODS: All patients undergoing PD between January 2008 and December 2012 were divided into two groups, one with aRHA and the other without. These groups were compared to identify differences in the intraoperative variables, the oncological clearance and the postoperative morbidity, mortality and hospital stay.

RESULTS: A total of 225 patients underwent PD, of which 43 (19.1%) patients were found to have either accessory or replaced right hepatic arteries (aRHA group). The aRHA was preserved in 79% of the patients. There was no significant difference in the intraoperative blood loss but operative time was prolonged, reflecting the complexity of the procedure [420 ± 44 (240-540) min vs 480 ± 45 (300-600) min, P < 0.05)]. There were no differences in the incidence of postoperative complications (pancreatic leak, pancreatic fistula, delayed gastric emptying and mortality) and hospital stay. Oncological clearance in the form of positive resection margins [13 (7.1%) vs 3 (6.9%)] and lymph node yield were also similar in the two groups.

CONCLUSION: An aRHA is found in approximately one fifth of patients undergoing PD. Preservation is technically possible in most patients and can increase the operative complexity but does not negatively affect the safety or oncological outcomes of the procedure.

Keywords: Pancreatoduodenectomy; Aberrant right hepatic artery; Arterial anomalies; Outcomes

Core tip: Appreciation and study of hepatic arterial anatomical variability is essential to the successful performance of complex pancreaticobiliary procedures. An aberrant right hepatic artery (aRHA) represents the vascular anomaly encountered most frequently during pancreatoduodenectomy (PD) and, because of its course, is most susceptible to intraoperative damage and tumor involvement. When an aRHA is present, the challenge in peripancreatic malignant disease is to balance its preservation and the need to achieve oncological clearance. In this study, we analyzed the incidence of aRHA and its relationship with the operative complexity, occurrence of complications and oncological clearance in a large cohort of patients undergoing PD.