Surgical anatomy of the gastroduodenal artery in Chinese adults and its clinical applications.

Background/aims: Hemorrhage occurs in 15-25% of duodenal ulcers, mostly on the posterior wall of the proximal duodenum. Erosion of the gastroduodenal artery is responsible for serious hemorrhages. Therefore, the relationship between bile duct and gastroduodenal artery should be discerned to prevent bile duct injury.
Methodology: Cadavers from 52 Chinese adults (44 males, 8 females) were dissected for the anatomic relationships of the GDA and bile duct.
Results: The gastroduodenal artery has many possible origins, with the common hepatic artery (92.3%) the most common. The mean distance between gastroduodenal artery and pylorus was 2.7 cm; arterial length (from its origin) was 1.2 cm. The relationships between gastroduodenal artery and bile duct could be divided into 4 anatomic types according to Prudhomme's classification. We found 22 samples (42%) of Type 1; 10 samples (19%) of Type 2; 14 samples (27%) of Type 3 (in 8 samples of Type 3, there was about 8mm thickness of pancreatic tissue between the artery and the bile duct); 6 samples (12%) of Type 4. In 12 cases (24%) there was no interposed pancreatic tissue.
Conclusions: These anatomic variations could lead to injury during surgical intervention. Our study provides detailed information about anatomic variability in Chinese adults that may help avoid such injury to the common bile duct during duodenal bleeding hemostasis.