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Tanaka T, Nakada T, Ito T, Kominami R, Sonomura T, Kagaya M, Kawai K, Honma S. Topographical relationship between the accessory hepatic duct and the hepatic artery system. Anat Sci Int 2020; 96:112-118. [PMID: 32914370 DOI: 10.1007/s12565-020-00568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Hepatic biliary injury is one of the most common complications in cholecystectomy and is frequently accompanied by arterial injuries. Because there are several anatomical variations of the hepatic ducts, including the accessory hepatic ducts (AHDs), it is important to consider not only the anatomical position of the hepatic ducts but also those of the AHDs in cholecystectomy. However, the topographical relationships between the AHDs and the hepatic arteries are still poorly understood. In the present study we show that AHDs were observed in 7 out of 59 (11.9%) of the cadavers. There was a single AHD in the 6 out of the 7 cadavers and double AHDs in one. In these cases, the right AHDs emerged from the anterior medial segment of the liver piercing the parenchyma, while the left AHDs emerged directly from the anterior part of the caudate lobe. The right AHDs ran anterior to the right hepatic artery, while the left AHDs ran posterior to the hepatic arteries. The topographical relationship between the AHD and the hepatic artery system was thus reversed in the cases of the right and the left AHDs.
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Affiliation(s)
- Takashi Tanaka
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Takayuki Nakada
- Anatomy Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Tetsufumi Ito
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Rieko Kominami
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Takahiro Sonomura
- Department of Anatomy, School of Dentistry, Asahi University, 1851 Hozumi, Mizuho, Gifu, 501-0296, Japan
| | - Miyuki Kagaya
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Katsushi Kawai
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Satoru Honma
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
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Kurahashi S, Komatsu S, Matsumura T, Fukami Y, Arikawa T, Saito T, Osawa T, Uchino T, Kato S, Suzuki K, Toda Y, Kaneko K, Sano T. A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy. Surg Endosc 2020; 34:2904-2910. [PMID: 32377838 DOI: 10.1007/s00464-020-07610-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Based on the spatial relationship of an aberrant right hepatic duct (ARHD) with the cystic duct and gallbladder neck, we propose a practical classification to evaluate the specific form predisposing to injury in laparoscopic cholecystectomy (LC). METHODS We retrospectively investigated the preoperative images (mostly magnetic resonance cholangiopancreatography) and clinical outcomes of 721 consecutive patients who underwent LC at our institute from 2015 to 2018. We defined the high-risk ARHD as follows: Type A: communicating with the cystic duct and Type B: running along the gallbladder neck or adjacent to the infundibulum (the minimal distance from the ARHD < 5 mm), regardless of the confluence pattern in the biliary tree. Other ARHDs were considered to be of low risk. RESULTS A high-risk ARHD was identified in 16 cases (2.2%): four (0.6%) with Type A anatomy and 12 (1.7%) with Type B. The remaining ARHD cases (n = 34, 4.7%) were categorized as low risk. There were no significant differences in the operative outcomes (operative time, blood loss, hospital stay) between the high- and low- risk groups. Subtotal cholecystectomy was applied in four cases (25%) in the high-risk group, a significantly higher percentage than the low-risk group (n = 1, 2.9%). In all patients with high-risk ARHD, LC was completed safely without bile duct injury or conversion to laparotomy. CONCLUSIONS Our simple classification of high-risk ARHD can highlight the variants located close to the dissecting site to achieve a critical view of safety and may contribute to avoiding inadvertent damage of an ARHD in LC.
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Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tatsuki Matsumura
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shoko Kato
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenta Suzuki
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yoko Toda
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Hu Y, Yu L, Xia F, Liang F, Cheng C, Huang Y, Xiao L. Effect of laparoscopic myomectomy on serum levels of IL-6 and TAC, and ovarian function. Exp Ther Med 2019; 18:3588-3594. [PMID: 31602235 PMCID: PMC6777216 DOI: 10.3892/etm.2019.7941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/18/2019] [Indexed: 01/24/2023] Open
Abstract
Effect of laparoscopic myomectomy on the serum levels of interleukin-6 (IL-6) and total antioxidant capacity (TAC), and the ovarian function of patients with uterine fibroids was studied. Ninety patients with uterine fibroids admitted to The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, from March 2013 to July 2014, were randomly divided into the experimental group (n=45) and the control group (n=45). The experimental group was treated with laparoscopic myomectomy, and the control group was treated with abdominal myomectomy. ELISA was used for detecting IL-6 and TAC content. Radioimmunoassay (RIA) was used for detecting serum ovarian function indicators, including estradiol (E2), follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Patients in the experimental group had significantly lower intraoperative blood loss, postoperative exhaust time, number of days to recovery and return to work, number of intraoperative fibroids removed, and length of stay than those in the control group (P<0.05). TAC expression level was significantly higher in the experimental group than that in the control group, on the 1st, 3rd and 5th day after surgery (P<0.05), while IL-6 expression was significantly lower in the experimental group than that in the control group at the same time points (P<0.05). FSH and LH expression levels were significantly lower in the experimental group than those in the control group (P<0.05) at 1, 3 and 6 months after surgery, while E2 expression level was significantly higher in the experimental group than that in the control group at the same time points (P<0.05). The incidence of postoperative complications of patients in the experimental group was significantly lower than that in the control group (P<0.05). Patients in the experimental group had significantly higher successful pregnancy rate than those in the control group (χ2=6.75, P<0.05). Reducing its effect on ovarian function, serum pain index and oxidative damage index of patients with uterine fibroid, laparoscopic myomectomy also reduces the incidence of postoperative complications and increases the pregnancy rate.
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Affiliation(s)
- Yanling Hu
- Department of Gynaecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Liyao Yu
- Department of Gynaecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Fen Xia
- Department of Gynaecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Fengqi Liang
- Department of Gynaecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Chao Cheng
- Department of Gynaecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yuhua Huang
- Department of Gynaecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Linqi Xiao
- Department of Gynaecology and Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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