The implications of the presence of an aberrant right hepatic artery in patients undergoing a pancreaticoduodenectomy.
OBJECTIVE
An aberrant right hepatic artery (ARHA) is a common anomaly and its implications for patients undergoing a pancreaticoduodenectomy (PD) have not yet been previously reported. We compared the outcomes following PD in patients with and without an ARHA. A novel classification of the anatomical course of ARHA, and surgical techniques for its identification and preservation are described herein.


METHODS
All patients undergoing PD between June 1, 2002, and May 31, 2007, 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, the postoperative complications, and the survival.


RESULTS
A total of 135 patients underwent PD of which 28 (20.8%) patients were found to have either accessory or replaced right hepatic arteries (ARHA group). There were no significant differences in the intraoperative variables (blood loss and operative time) and the incidence of postoperative complications (pancreatic leak and delayed gastric emptying). Oncological clearance (nodal yield and resection margins) and survival were also similar in the two groups.


CONCLUSIONS
The surgical and oncological outcomes of PD remain unaffected by the presence of ARHA provided that the anatomy is recognized and appropriately managed. Aberrant right hepatic artery can be classified into three types according to their anatomical relationship with the head of the pancreas.
Jah
Asif
A
Department of Hepatobiliary and Transplant Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Jamieson
Neville
N
Huguet
Emmanuel
E
Praseedom
Raaj
R
D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005746:Gastric Emptying; D006499:Hepatic Artery / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome