Significance of Accessory Left Hepatic Artery in Laparoscopic Radical Gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGLin , ZHANGHai-tao , GUHai-liang , WAGNFei ,  ZHAOXin

Department of General Surgery Ⅶ, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China;

Corresponding author：

ZHAOXin, Email: zhaox@suda.edu.cn

Keywords：

Accessory left hepatic artery; Laparoscopic radical gastrectomy; Liver abscess; Intrahepatic biloma

DOI：

10.7507/1007-9424.20160281

Video：

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Objective To evaluate the significance of the accessory left hepatic artery during the procedure of laparoscopic radical gastrectomy for gastric cancer. Methods Clinical data and imaging data of 120 patients with gastric cancer who underwent laparoscopic radical gastrectomy between January 2014 and June 2015 were retrospectively collected, to summarize the significance of accessory left hepatic artery in laparoscopic radical gastrectomy for gastric cancer, and to summarize the main points during the operation. Results Nine patients (7.5%) had the accessory left hepatic artery in the whole group of 120 patients. Ligation was performed at the beginning of the distal left gastric artery or each branch near the stomach. All patients recovered well postoperatively. There was no significant difference in the total bilirubin, glutamic-pyruvic transaminase, and glutamic-oxalacetic transaminase on 3 days before surgery, 1, 3, and 7 days after surgery (P > 0.05). In addition, there was no occurrence of liver abscesses and intrahepatic biloma. Conclusions The incidence of accessory left hepatic artery variation is at a high incidence rate in clinical patients. It needs to be paid attention to protect the accessory left hepatic artery during the laparoscopic radical gastrectomy for gastric cancer, in order to avoid the occurrence of liver abscess and intrahepatic biloma.

Citation： WANG Lin, ZHANG Hai-tao, GU Hai-liang, WAGN Fei, ZHAO Xin. Significance of Accessory Left Hepatic Artery in Laparoscopic Radical Gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(9): 1101-1105. doi: 10.7507/1007-9424.20160281 Copy

1.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopic-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2):146-148.
2.	Noh SH, Hyung WJ, Cheong JH. Minimally invasive treatment for gastric cancer:approaches and selection process. J Surg Oncol, 2005, 90(3):188-194.
3.	Pugliese R, Maggioni D, Sansonna F, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc, 2007, 21(1):21-27.
4.	Noshiro H, Nagai E, Shimizu S, et al. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc, 2005, 19(12):1592-1596.
5.	Kunisaki C, Makino H, Takagawa R, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc, 2009, 23(2):377-383.
6.	余佩武, 钱锋, 郝迎学, 等.腹腔镜胃癌根治术726例的疗效分析.中华消化外科杂志, 2011, 10(1):44-47.
7.	余佩武, 钱锋, 罗华星.腹腔镜胃癌根治术的临床疗效.中华消化外科杂志, 2008, 7(1):38-40.
8.	Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg, 1966, 112(3):337-347.
9.	殷永芳, 聂诗鑫, 涂植涛, 等.肝动脉解剖变异及其临床意义.中国临床解剖学杂志, 2011, 29(2):174-178.
10.	叶启发.肝动脉变异与肝移植的关系.中国现代手术学杂志, 2006, 10(6):401-403.
11.	López-Andújar R, Moya A, Montalvá E, et al. Lessons learned from anatomic variants of the hepatic artery in 1081 transplanted livers. Liver Transpl, 2007, 13(10):1401-1404.
12.	Xu X, Zheng SS. Variations and reconstruction of the hepatic artery in liver transplantation. Hepatobiliary Pancreat Dis Int, 2006, 5(2):170-172.
13.	Gruttadauria S, Foglieni CS, Doria C, et al. The hepatic artery in liver transplantation and surgery:vascular anomalies in 701 cases. Clin Transplant, 2001, 15(5):359-363.
14.	徐伟, 翟博.腹腔镜胃癌根治术47例.中国现代普通外科进展, 2010, 13(6):487-489.
15.	Covey AM, Brody LA, Maluccio MA, et al. Variant hepatic arterial anatomy revisited:digital subtraction angiography performed in 600 patients. Radiology, 2002, 224(2):542-547.
16.	Charnsangavej C, Chuang VP, Wallace S, et al. Angiographic classification of hepatic arterial collaterals. Radiology, 1982, 144(3):485-494.
17.	Koehler RE, Korobkin M, Lewis F. Arteriographic demonstration of collateral arterial supply to the liver after hepatic artery ligation. Radiology, 1975, 117(1):49-54.
18.	Huang CM, Chen QY, Lin JX, et al. Short-term clinical implications of the accessory left hepatic artery in patients undergoing radical gastrectomy for gastric cancer. PLoS One, 2013, 8(5):e64300.
19.	路建宽, 袁广胜, 杜世珠, 等.胆汁瘤的形成原因及介入治疗.当代医学, 2009, 15(11):212-214.
20.	Delatire B, Blezel E, Samatna G, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Surg Laparosc Endosc Percutan Tech, 2002, 12(6):412-419.
21.	贾中芝, 冯耀良.胆汁瘤的形成原因及治疗.中国介入放射学学术大会, 广州, 2010.
22.	李雪华, 孙灿辉, 冯仕庭, 等. 64层螺旋CT血管造影及融合技术对胃周动脉的评价.中华胃肠外科杂志, 2012, 15(6):594-598.
23.	Guiney MJ, Kruskal JB, Sosna J, et al. Multi-detector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation. Radiology, 2003, 229(2):401-407.
24.	Brennan DD, Zamboni G, Sosna J, et al. Virtual Whipple:preoperative surgical planning with volume-rendered MDCT images to identify arterial variants relevant to the Whipple procedure. AJR Am J Roentgenol, 2007, 188(5):W451-W455.
25.	Kawamoto S, Montgomery RA, Lawler LP, et al. Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors. AJR Am J Roentgenol, 2003, 180(6):1633-1638.

1. Kitano S, Iso Y, Moriyama M, et al. Laparoscopic-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2):146-148.
2. Noh SH, Hyung WJ, Cheong JH. Minimally invasive treatment for gastric cancer:approaches and selection process. J Surg Oncol, 2005, 90(3):188-194.
3. Pugliese R, Maggioni D, Sansonna F, et al. Total and subtotal laparoscopic gastrectomy for adenocarcinoma. Surg Endosc, 2007, 21(1):21-27.
4. Noshiro H, Nagai E, Shimizu S, et al. Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc, 2005, 19(12):1592-1596.
5. Kunisaki C, Makino H, Takagawa R, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc, 2009, 23(2):377-383.
6. 余佩武, 钱锋, 郝迎学, 等.腹腔镜胃癌根治术726例的疗效分析.中华消化外科杂志, 2011, 10(1):44-47.
7. 余佩武, 钱锋, 罗华星.腹腔镜胃癌根治术的临床疗效.中华消化外科杂志, 2008, 7(1):38-40.
8. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg, 1966, 112(3):337-347.
9. 殷永芳, 聂诗鑫, 涂植涛, 等.肝动脉解剖变异及其临床意义.中国临床解剖学杂志, 2011, 29(2):174-178.
10. 叶启发.肝动脉变异与肝移植的关系.中国现代手术学杂志, 2006, 10(6):401-403.
11. López-Andújar R, Moya A, Montalvá E, et al. Lessons learned from anatomic variants of the hepatic artery in 1081 transplanted livers. Liver Transpl, 2007, 13(10):1401-1404.
12. Xu X, Zheng SS. Variations and reconstruction of the hepatic artery in liver transplantation. Hepatobiliary Pancreat Dis Int, 2006, 5(2):170-172.
13. Gruttadauria S, Foglieni CS, Doria C, et al. The hepatic artery in liver transplantation and surgery:vascular anomalies in 701 cases. Clin Transplant, 2001, 15(5):359-363.
14. 徐伟, 翟博.腹腔镜胃癌根治术47例.中国现代普通外科进展, 2010, 13(6):487-489.
15. Covey AM, Brody LA, Maluccio MA, et al. Variant hepatic arterial anatomy revisited:digital subtraction angiography performed in 600 patients. Radiology, 2002, 224(2):542-547.
16. Charnsangavej C, Chuang VP, Wallace S, et al. Angiographic classification of hepatic arterial collaterals. Radiology, 1982, 144(3):485-494.
17. Koehler RE, Korobkin M, Lewis F. Arteriographic demonstration of collateral arterial supply to the liver after hepatic artery ligation. Radiology, 1975, 117(1):49-54.
18. Huang CM, Chen QY, Lin JX, et al. Short-term clinical implications of the accessory left hepatic artery in patients undergoing radical gastrectomy for gastric cancer. PLoS One, 2013, 8(5):e64300.
19. 路建宽, 袁广胜, 杜世珠, 等.胆汁瘤的形成原因及介入治疗.当代医学, 2009, 15(11):212-214.
20. Delatire B, Blezel E, Samatna G, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Surg Laparosc Endosc Percutan Tech, 2002, 12(6):412-419.
21. 贾中芝, 冯耀良.胆汁瘤的形成原因及治疗.中国介入放射学学术大会, 广州, 2010.
22. 李雪华, 孙灿辉, 冯仕庭, 等. 64层螺旋CT血管造影及融合技术对胃周动脉的评价.中华胃肠外科杂志, 2012, 15(6):594-598.
23. Guiney MJ, Kruskal JB, Sosna J, et al. Multi-detector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation. Radiology, 2003, 229(2):401-407.
24. Brennan DD, Zamboni G, Sosna J, et al. Virtual Whipple:preoperative surgical planning with volume-rendered MDCT images to identify arterial variants relevant to the Whipple procedure. AJR Am J Roentgenol, 2007, 188(5):W451-W455.
25. Kawamoto S, Montgomery RA, Lawler LP, et al. Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors. AJR Am J Roentgenol, 2003, 180(6):1633-1638.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Significance of Accessory Left Hepatic Artery in Laparoscopic Radical Gastrectomy

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