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International Journal of Anatomical Sciences 2010, 1: 31-33.

Research Paper

Variations in the Origin of Left Hepatic Artery

Pushpalatha K,a Shamasundar NM,a Najma M,a Shanmuganathan K.b

aDepartment of Anatomy, JSS Medical College, Mysore, Karnataka, India. bDepartment of

Anatomy, Aarubadevidu Medical College, Pondicherry, India.

Key Words: left hepatic artery, left gastric artery, celiac trunk, common hepatic artery, liver surgery

Abstract: Hepatic artery is the gateway to successful hepatobiliary surgeries. Left hepatic artery usually arises from the common hepatic artery. Aberrant left hepatic artery may arise from the left gastric / gastro duodenal / right hepatic / celiac trunk / splenic or from superior mesenteric artery (Williams et al., 1996). The origin of Left hepatic artery was studied in 50 cases by dissection method. After dissecting the branching pattern of common hepatic artery was noted and arteries were painted using red  fevicryl  paint  and  photograph  was  taken.  Each  photograph  was  given  the specimen number. Left hepatic artery was seen arising from left gastric in 6 cases, from hepatic artery proper in 38 cases and from common hepatic in 6 cases. Left hepatic from left gastric lies in hepatogastric ligament and one must know this variation before dividing the ligament to reach the gastro esophageal junction.

Hepatic artery is the gateway to successful  hepatobiliary  surgery. Introduction  of  laparoscopic cholecystectomy has stimulated a renewed interest in the anatomy of the hepatic artery. Hepatic artery anatomy has been described adequately. Common hepatic artery arises from coeliac trunk and divides into gastro duodenal and hepatic artery proper. Hepatic artery proper divides into left and right hepatic artery (Williams et al., 1996). Aberrant left hepatic artery may arise from the left gastric / coeliac trunk directly / right hepatic  /  splenic  artery  /  superior mesenteric/ gastro duodenal or from  aorta (Hollinshed and Rosse, 1985). A new emphasis is given to this by the introduction of liver transplantation hence the present study.

Materials and Methods

50 specimens included embalmed 35 cadavers given for dissection to undergraduate students in department of Anatomy and 15 fresh specimens from postmortem bodies from department of forensic medicine, JSSMC, Mysore. Common Dissection method was used to study the specimens.   After dissecting the branching pattern of Common hepatic artery was noted and arteries were painted using red fevicryl paint and photograph was taken. Each photograph was given the specimen number. Following statistical methods were employed in the present study

o Contingency Table analysis

o Chi-square test

Observations

Left hepatic artery arising from Hepatic artery proper  was  seen  in  38  cases,  from Left gastric in 6 cases and from Common hepatic in 6 cases (Table-1). The left hepatic arising  from  left  gastric  artery was  found within the layers of hepatogastric ligament.

 Chi-square value of 40.96 was found to be highly significant (P<. 000), indicating that  maximum number of cases was observed in HP (76%), followed by LG (12%) and CH (12%).  These figures are diagrammatically represented in Fig. 1.

Table 1 Frequency in variation of Left hepatic

Frequency Percent

Cumulat iv e

Percent

LH HP

38

76.0 76.0
LG

6

12.0 88.0
CH

6

12.0 100.0
Total

50

100.0


Fig. 1 Bar diagram showing the frequency in variation of Left hepatic arter

LH-Left   hepatic,   CH-Common   hepatic,   HP- Hepatic  proper,  LG-Left  gastric. Chi-square =40.96; P< .000 (Highly significant)

Fig. 2 Left hepatic artery arising from Left gastric artery

image004

 

 

 

 

 

LH-Left hepatic, CH-Common hepatic, HP-Hepatic   proper,   LG-Left   gastric, CT-Celiac trunk, GD-Gastro duodenal, IP-Inferior phrenic artery, Cy-Cystic artery, RG-Right gastric, S – Splenic artery, S.N 9-Specimen number 9.

Discussion

Left  hepatic  artery  usually  arises from the common hepatic artery. Aberrant left hepatic artery may arise from the left gastric, celiac trunk directly, right hepatic, splenic artery, superior mesenteric, sastro duodenal or from aorta.

Source Michel RM Jones &KJ Hardy Presentstudy
CH 85% 81% 12%
HP - - 76%
LG 11% 15% 12%
Others 4% 4% 0%

Table 2 Origin of left hepatic compared with other study
In the present study Left hepatic artery was seen arising from Hepatic artery proper in 76% of cases but Michels (1955) observed that in 85% of cases left hepatic was  arising  from  Common  hepatic  and Jones and Hardy   (2001) observed that in 81% of cases left hepatic was arising from Common hepatic. Present study value of left hepatic artery from left gastric artery was almost near to their study (Table 2). They have  not   mentioned   about   Left   hepatic artery  from   hepatic   artery  proper.   This difference may be because we have considered the hepatic artery into common hepatic and hepatic artery proper.

Conclusion

Left hepatic arising from left gastric was observed in 12% of cases. This branch lies in the hepato gastric ligament and one must consider the possibility of such an artery before dividing the ligament to reach the   gastro   esophageal   junction   (Jones,2001). Surgeons should be aware of this during ligating left gastric artery because sometimes it forms the sole blood supply to the left lobe of liver.

References

Hollinshead  H,   Rosse  C  (1985)  Text  book  of Anatomy. 4th Edition. Philadelphia:  Harper and Row. 324-640.

Jones RM, Hardy KJ (2001) The hepatic artery – a reminder of  surgical anatomy.  J  R  Coll  Surg Edinb, 46: 168-170.Michels NA (1955) Blood supply and Anatomy of the upper abdominal organs. USA: JB Lippincott Company. 32-73.Williams PL, Bannster LH, Berry M. et al (1996) Gray’s anatomy. 38th Edition. London: Churchill Livingstone. 1548-1553.

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