title: Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Rammohan
authors.affiliation: 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.
authors.forename: Ravichandran
authors.initials: R
authors.lastname: Palaniappan
authors.affiliation: 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.
authors.forename: Anbalagan
authors.initials: A
authors.lastname: Pitchaimuthu
authors.affiliation: 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.
authors.forename: Kamalakannan
authors.initials: K
authors.lastname: Rajendran
authors.affiliation: 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.
authors.forename: Senthil Kumar
authors.initials: SK
authors.lastname: Perumal
authors.affiliation: 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.
authors.forename: Kesavan
authors.initials: K
authors.lastname: Balaraman
authors.affiliation: 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.
authors.forename: Ravi
authors.initials: R
authors.lastname: Ramasamy
authors.affiliation: 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.
authors.forename: Jeswanth
authors.initials: J
authors.lastname: Sathyanesan
authors.affiliation: 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.
authors.forename: Manoharan
authors.initials: M
authors.lastname: Govindan
keywords: Aberrant right hepatic artery; Arterial anomalies; Outcomes; Pancreatoduodenectomy