title: Aberrant left hepatic artery in laparoscopic antireflux procedures.
abstract: BACKGROUND
  The aberrant left hepatic artery (ALHA) is an anatomic variation that may present an obstacle in laparoscopic antireflux procedures. Based on our experience, we addressed the following questions: How frequent is ALHA? When or why is it divided? What is the outcome in patients after division of the ALHA?
  
  
  METHODS
  From a prospective collected database of 720 patients undergoing laparoscopic antireflux surgery, we collected the following information: presence of an ALHA, clinical data, diagnostic workup, operative reports, laboratory data, and follow-up data.
  
  
  RESULTS
  In 57 patients (7.9%) (37 men and 20 women; mean age, 51 +/- 15.7 years), an ALHA was reported. Hiatal dissection was impaired in 17 patients (29.8%), requiring division of the ALHA. In three patients (5.3%), the artery was injured during dissection; in one case (1.8%), it was divided because of ongoing bleeding. Ten of the divided ALHA (55.5%) were either of intermediate size or large. Mean operating time was 2.2 +/- 0.8 h; mean blood loss was 63 +/- 49 ml. Postoperative morbidity was 5.3% and mortality was 0%. None of the patients with divided hepatic arteries had postoperative symptoms related to impaired liver function. Postoperatively, two patients (11.7%) had transient elevated liver enzymes. At a mean follow-up of 28.5 +/- 12.8 months, no specific complaints could be identified.
  
  
  CONCLUSIONS
  ALHA is not an uncommon finding in laparoscopic antireflux surgery and may be found in > or =8% of patients. Division may be required due to impaired view of the operating field or bleeding. Patients do not experience clinical complaints after division, but liver enzymes may be temporarily elevated.
authors.affiliation: Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Klingler
authors.forename: M H
authors.initials: MH
authors.lastname: Seelig
authors.forename: N R
authors.initials: NR
authors.lastname: Floch
authors.forename: S A
authors.initials: SA
authors.lastname: Branton
authors.forename: M C
authors.initials: MC
authors.lastname: Freund
authors.forename: N
authors.initials: N
authors.lastname: Katada
authors.forename: R A
authors.initials: RA
authors.lastname: Hinder
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006499:Hepatic Artery / Q000002:abnormalities*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged