Abstract：
OBJECTIVE: Preoperative comprehension of the anatomical variations of the hepatic artery and bile duct is essential for safe laparoscopic surgery for pancreaticobiliary maljunction (PBM). This study aimed to investigate the impact of anatomical variations of the hepatic artery and bile duct on surgical technique and postoperative complications.
METHODS: We conducted a retrospective review of patients with PBM who underwent laparoscopic surgery at our institution between January 2014 and December 2022 to investigate anatomical variations in the hepatic artery and bile duct, surgical technique, and postoperative complications.
RESULTS: We included 112 patients with PBM, with a median age of 4 years (interquartile range, 0-55). Overall, 29 of 112 patients had an aberrant right hepatic artery (ARHA) running ventral to the common hepatic duct (CHD), and they underwent hepaticojejunostomy on the ventral side of the ARHA. Additionally, eight of 112 patients had an aberrant posterior hepatic duct (APHD), which was joined to the CHD in all but one case. The presence of APHD was associated with postoperative bile leak occurrence.
CONCLUSIONS: Performing hepaticojejunostomy ventral to the ARHA is important to prevent complications. Furthermore, APHD may be a risk factor for postoperative bile leak and requires careful bile duct plasty.
METHODS: We conducted a retrospective review of patients with PBM who underwent laparoscopic surgery at our institution between January 2014 and December 2022 to investigate anatomical variations in the hepatic artery and bile duct, surgical technique, and postoperative complications.
RESULTS: We included 112 patients with PBM, with a median age of 4 years (interquartile range, 0-55). Overall, 29 of 112 patients had an aberrant right hepatic artery (ARHA) running ventral to the common hepatic duct (CHD), and they underwent hepaticojejunostomy on the ventral side of the ARHA. Additionally, eight of 112 patients had an aberrant posterior hepatic duct (APHD), which was joined to the CHD in all but one case. The presence of APHD was associated with postoperative bile leak occurrence.
CONCLUSIONS: Performing hepaticojejunostomy ventral to the ARHA is important to prevent complications. Furthermore, APHD may be a risk factor for postoperative bile leak and requires careful bile duct plasty.
摘要：
目的：术前了解肝动脉和胆管的解剖变异对于腹腔镜胰胆管合流异常（PBM）的安全手术至关重要。本研究旨在探讨肝动脉和胆管解剖变异对手术技术和术后并发症的影响。
方法：我们对2014年1月至2022年12月在我院接受腹腔镜手术的PBM患者进行了回顾性研究，以研究肝动脉和胆管的解剖变异。外科技术,术后并发症。
结果：我们纳入了112例PBM患者，平均年龄为4岁(四分位间距，0-55）。总的来说,112例患者中有29例患有异常的右肝动脉（ARHA），其腹侧延伸至总肝管（CHD），他们在ARHA的腹侧接受了肝空肠吻合术。此外,112例患者中有8例患有异常肝后导管（APHD），除一例外，其他所有病例都加入了冠心病。APHD的存在与术后胆漏的发生有关。
结论：对ARHA进行肝空肠腹侧吻合术对预防并发症很重要。此外，APHD可能是术后胆漏的危险因素，需要仔细的胆管成形术。
方法：我们对2014年1月至2022年12月在我院接受腹腔镜手术的PBM患者进行了回顾性研究，以研究肝动脉和胆管的解剖变异。外科技术,术后并发症。
结果：我们纳入了112例PBM患者，平均年龄为4岁(四分位间距，0-55）。总的来说,112例患者中有29例患有异常的右肝动脉（ARHA），其腹侧延伸至总肝管（CHD），他们在ARHA的腹侧接受了肝空肠吻合术。此外,112例患者中有8例患有异常肝后导管（APHD），除一例外，其他所有病例都加入了冠心病。APHD的存在与术后胆漏的发生有关。
结论：对ARHA进行肝空肠腹侧吻合术对预防并发症很重要。此外，APHD可能是术后胆漏的危险因素，需要仔细的胆管成形术。
