OP 125. Review of the Surgical Anatomy of the Human Liver and Its Surgical Relevancy in Liver Resection and Partial Liver Transplantation

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M. Kiss, A Szuák, K. Nemeth, Z. Pápai, I. Horti, S. Kovács, Z. Kürti, T. Nguyen Thuy, E. Gáti, L. Fekete, I. Dudás, E. Botos, C. Korom, K. Karlinger, K. Törö, L. Kobori, A. Nemeskeri

Chair(s): Attila Balogh, Thomas Hubert & Krisztián Szigeti

15:50 - 16:00h at Erszebet Room (A)

Categories: Surgical Anatomy, Oral Session

Session: Oral Session XIV - Surgical Anatomy

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Background
The precise knowledge of hilar and intrahepatic biliary and vascular variations is essential to further reduce the incidence of intra- and postoperative complications of partial liver transplantation and liver resections. Our aim was to investigate the frequency and surgical relevance of these anatomical variations.

Material and Methods
A new synthetic resin corrosion cast method was worked out and more than 450 human liver casts were made. Furthermore, for post mortem simulation of liver splitting, organs were injected with very special resin mixture before fixation, CT scan and 3D CT reconstruction were applied.

Result
The statistical analysis of 140 biliary duct preparations revealed new variations and subvariations and differences in frequencies of certain biliary duct variations, compared to data available in the international literature. The branching patterns and anastomoses of great surgical importance between the right and middle hepatic veins were observed and analyzed on 55 casts. Patterns of intrahepatic branching and extrahepatic arterial blood supply showed significant differences in comparison to data published by others (65casts). The hilar branching of portal vein displayed normal anatomy in 60% of preparations (70casts). Using our new model liver preparations, different types of splits could be planned, performed like in living.

Conclusion
We provide the first complex detailed data on the incidence of hepatic vascular and biliary variations in the Hungarian population. Differences among the available statistics may derive from genetic differences among populations. We organized successful international surgical training hands-on courses based on our model of liver split simulation.