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Summary Nodal involvement of the hepatic pedicle is variable and depends on the underlying hepato-bilio-pancreatic pathology. Although its value for ultimate prognosis has not been demonstrated, lymphadenectomy is usually performed to determine tumor stage and to inform the decision about eventual adjuvant treatment. Lymph node dissection of the hepatic pedicle requires a thorough understanding of the anatomy of hepatic lymphatic drainage as well as accurate analysis of pre-operative imaging in order to identify and locate abnormal lymph and to rule out anatomical variations that might complicate the surgical procedure. [ABSTRACT FROM AUTHOR]

Avaliaram-se as alterações morfológicas, morfométricas e ultraestruturais que ocorreram no baço devido à isquemia produzida pelo clampeamento total do pedículo hepático. Para tanto, foram utilizados 40 ratos machos, distribuídos em quatro grupos de 10 animais. O grupo-controle (C) não foi submetido à isquemia, e os grupos tratados (E1, E2e E3) foram submetidos ao clampeamento por 10, 20 e 30 minutos, respectivamente. Fragmentos do baço foram retirados e analisados histologicamente pela microscopia de luz (hematoxilina-eosina, ferrocianeto-férrico) e pela microscopia eletrônica de transmissão. Os resultados demonstraram que 10 minutos de clampeamento do pedículo hepático são suficientes para apresentar sinais de congestão esplênica e 20 e 30 minutos promovem intensa digestão de hemácias pelos macrófagos, com presença de grânulos de ferro (hemossiderina) no parênquima esplênico.The macro and microscopic alterations that occurred in the spleen during an ischemia produced by the hepatic pedicle total clamping were studied. Forty male rats were distributed in four groups of 10 animals each. The control group (C) was not submitted to ischemia and the treated groups (E1, E2, and E3) were submitted to the clamping during 10, 20, and 30 minutes, respectively. Spleen fragments were collected and histologically analyzed by the light microscopy (eosin-hematoxilin and ferric ferrocyanide) and by the transmission electron microscopy. The results showed that 10 minutes of hepatic pedicle total clamping was enough produce signs of splenic congestion and 20 and 30 minutes promoted intense red bood cels digestion by the macrophages with the presence of iron granules (hemosiderin) in the splenic parenchyma.

The knowledge in detail of the anatomy of the hepatic pedicle is critical when operating it and its surroundings. The presence of anatomic variations is higher at the arterial component level than at the bile component level or venous component level, which in the 90% of the cases it appears as the classic description. The presented case in this work implies a very low frequency of appearance. For this reason, the surgeon must be alert at the moment of making a decision so as to avoid injuries that may put the patient's life at risk. [ABSTRACT FROM AUTHOR]

Abstract: A case of a “double hepatomesenteric artery”, i.e. two persisting hepatic arteries arising from the superior mesenteric artery, is reported. Also observed was a lack of systematisation of the pancreaticoduodenal arteries. The variant, which does not appear to have been previously reported in the literature, was observed when dissecting the vessels of the duodenal bulb in a preserved male cadaver injected with neoprene latex. Its embryological origin, as well as the clinical, radiological (diagnostic or interventional) and surgical implications, are discussed. [ABSTRACT FROM AUTHOR]

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Background: This study details our experience with an improved surgical technique involving the hepatic pedicle during laparoscopic left hemihepatectomy (LLH)., Methods: We describe an improved laparoscopic technique to extraparenchymally divide the left hepatic pedicle. A retrospective analysis of all of the patients who underwent laparoscopic liver procedures between 2002 and 2012 was conducted. The patients were divided into two groups, an early LLH group (ELLH group) and a recent LLH group (RLLH group), based on the surgical approach used for the left hepatic pedicle., Results: A total of 72 cases of LLH (26 ELLH and 46 RLLH) were identified. The RLLH group exhibited a shorter median operative time, median length of hospital stay, and lower median blood loss compared to the ELLH group (182, 162.5-223.7 versus 232.5, 200-357.5 minutes, P < .01; 5, 4.2-7 versus 7, 6-8.7 days, P < .05; 150, 100-257.5 versus 300, 200-337.5 mL, P < .05, respectively). No perioperative mortality was observed., Conclusions: This study confirms that our improved surgical technique for LLH is practical, safe, and effective. The main advantage of this method compared to other techniques is the possibility of attaining rapid and precise control of vascular inflow, thus facilitating LLH., Competing Interests: Statement No competing financial interests exist.