Clinical surgery–international
Relationship between right portal and biliary systems based on reclassification of the liver

https://doi.org/10.1016/j.amjsurg.2006.10.007Get rights and content

Abstract

Background

Although the anatomy of the right portal and biliary systems and their interrelationships must be understood to safely and satisfactorily perform left-sided resection of hilar cholangiocarcinoma or right-lobe living donor liver transplantation, the anatomies of the right portal and biliary systems are extremely difficult to understand.

Methods

A total of 60 patients with normal liver underwent computed tomography during both portography and cholangiography to evaluate relationships between the right biliary and portal systems based on reclassification of the liver to divide the right liver into 3 segments.

Results

All ventral and posterior ducts constantly join medially to the anterior portal trunk. In contrast, some dorsal ducts join the ventral duct medially and others join the posterior duct lateral to the anterior trunk.

Conclusions

Reclassification of the liver to divide the right liver into 3 segments facilitates an understanding of relationships between the right portal and biliary systems.

Section snippets

Patients and Methods

Between April 2001 and May 2005, a total of 36 patients underwent percutaneous transhepatic biliary drainage as a result of obstructive jaundice, and 46 patients underwent drip-infusion cholangiography–computed tomography (CT) for preoperative evaluation of laparoscopic cholecystectomy. Of these patients, 71 met the following inclusion criteria: no lesions in the liver, no cirrhosis, no extrahepatic lesions distorting the intrahepatic venous anatomy, and no previous liver surgery. Another 11

Confluence patterns of left, anterior, and posterior ducts

Confluence patterns were classified as type I (38 patients; 63%), normal configuration; type II (14 patients; 23%), triad confluence; type III (7 patients; 12%), posterior segmental duct joining left hepatic duct; or type IV (1 patient; 2%), distal confluence of the right posterior segmental duct. In type I, the anterior and posterior ducts unite to form the right duct, then the right and left ducts unite. In type II, the anterior, posterior, and left ducts unite immediately. In type III, the

Comments

Relationships between the left portal and biliary systems have been analyzed thoroughly using ex vivo corrosion casts [8] and in vivo radiologic examination [11], and is not so difficult to understand. The left biliary ducts are located cranial to the transverse and umbilical portions. Three distinct types can be identified: the segment 2 duct (B2) and segment 3 duct (B3) unite lateral to the umbilical portion, which lies on the umbilical fissure, then the segment 4 duct (B4) joins medial to

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