Anatomic variation and introperative disposal of right hepatic artery in pancreaticoduodenectomy

Anatomic variation of right hepatic artery (RHA) is not rare in clinical. we retrospective reviewed the clinical data of 179 patients underwent pancreaticoduodenectomy (PD) between January 2012 and June 2017 in Department of Hepatobiliary Surgery, Hospital of Binzhou Medical University, Shandong Province, China. 28 patients from them presented variant RHA including replaced RHA (rRHA) and accessory RHA (aRHA), and the incidence of aberrant RHA was about 15.64%. The variation was confirmed with preoperative imaging in 25 cases by contrast-enhanced computed tomographic (CT) and the preoperative diagnostic accuracy was up to 89.29% in our study. The duration of operation in variant group was prolonged than normal and there was a statistical difference between two groups, no difference was demonstrated in estimated amount of blood loss and postoperative complications including biliary fistula, pancreatic fistula, chylous fistula, intraperitoneal haemorrhage between two groups. It is essential for surgeons to be vigilant for rRHA or aRHA to avoid potentially disastrous complications and the best introperative disposal, only if transection and reconstruction is unavoidable, is to dissect and preserve despite it may cost much more time.