Human liver umbilical fissure variants: pons hepatis (ligamentum teres tunnel)

Cawich, Shamir O; Gardner, Michael L. G.; Shetty, Ramnanand; Pearce, Neil; Deshpande, Rahul; Naraynsingh, Vijay; Armstrong, Thomas

doi:10.1007/s00276-021-02688-8

Cited by 3 publications

(4 citation statements)

References 31 publications

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“…Raw data extracted from the published studies were used to calculate the global prevalence of anatomic variants[ 4 ]. The global prevalence was defined as the total number of individuals with a defined anatomic variant divided by the sum of the total number of individuals in each study.…”

Section: Methodsmentioning

confidence: 99%

Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review

Cawich¹,

Sinanan²,

Deshpande³

et al. 2021

WJGE

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BACKGROUND In the classic descriptions of the human liver, the common hepatic duct forms at the confluence of left and right hepatic ducts. Many authors have documented variations in the intra-hepatic ductal system, but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations. AIM To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography (MRC) in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean. Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders. METHODS This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean. We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1, 2017 to March 31, 2019. Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang’s classification. A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant. The variants in our population were compared to the global population. RESULTS There were 152 MRCs evaluated in this study in 86 males and 66 females. There were 109 (71.7%) persons with “classic” biliary anatomy (type A1) and variants were present in 43 (28.3%) persons. There was no statistical relationship between the presence of anatomic variants and gender or ethnicity. We encountered the following variants: 29 (19.1%) type A2, 7 (4.6%) type A3, 6 (3.95%) type A4, 0 type A5 and a single variant (quadrification) that did not fit the classification system. Compared to the global prevalence, our population had a significantly greater occurrence of A1 anatomy (71.7% vs 62.6%; P = 0.0227) and A2 trifurcations (19.1% vs 11.5%; P = 0.0069), but a significantly lower incidence of A3 variants (4.61% vs 11.5%; P = 0.0047). CONCLUSION There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics. Specifically, persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.

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Section: Methodsmentioning

confidence: 99%

Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review

Cawich¹,

Sinanan²,

Deshpande³

et al. 2021

WJGE

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“…Existe a possibilidade de que, a partir desta remodelação embriológica, possam ocorrer diversas variantes de configuração dos ductos hepáticos direito e esquerdo. 13,14 O ducto cístico é descrito como sendo o de maior variabilidade anatômica. Tal fato por si só demonstra a importância da dissecação cuidadosa desta estrutura durante as colecistectomias.…”

Section: Discussionunclassified

Trato Biliar: Variações Anatômicas E Sua Importância Na Prática Cirúrgica

Sigwalt¹

2022

BioSCIENCE

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RESUMO – Introdução: O trato biliar, conjunto formado pela vesícula biliar e estruturas relacionadas à sua função, tem descrição clássica nos livros-texto de anatomia. Entretanto, foge ao ensino convencional o detalhamento de variações anatômicas. Objetivo: Descrever as principais variações anatômicas conhecidas referentes à vesícula biliar e suas estruturas. Método: Revisão narrativa de literatura, em que foram analisadas as bases de dados SciELO e PubMed com filtro ajustado para busca entre os anos 2000 e 2021. Utilizou-se como descritores: “Variação anatômica”, “Trato biliar” e “Lesões cirúrgicas”. Resultado: As principais variações anatômicas inerentes ao trato biliar são: 1) alterações da inserção do ducto cístico na via biliar principal; 2) variações da árvore biliar principal com inserções variáveis, presença de múltiplos ductos hepáticos 3) ausência ou presença de múltiplas vesículas biliares; 4) identificação de ductos biliares aberrantes subvesiculares (Ductos de Luschka). Conclusão: O conhecimento das variações anatômicas no trato biliar é importante e a revisão realizada ajudará a preencher lacunas no aprendizado acadêmico das vias biliares, além de fornecer aos cirurgiões conhecimentos potencialmente despercebidos. PALAVRAS-CHAVE - Variação anatômica. Trato biliar. Lesões cirúrgicas.

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“…The frequency of the hepatic bridge varies in the literature. Sugarbaker found a frequency of 49% in 102 patients [56], while Cawich et al reported a prevalence of 40.9% in 66 cadavers [62]. Other studies reported lower incidences-22.85% and 30%, respectively [63,64].…”

Section: Base Of the Round Ligament And The Hepatic Bridgementioning

confidence: 99%

“…Sugarbaker established a classification into four types: Type O-no hepatic bridge, where the base of the round ligament is visible; Type I-less than one-third of the umbilical fissure is covered by liver parenchyma; Type II-the hepatic bridge covers up to two-thirds of the fissure; Type III-more than two-thirds is covered by the liver parenchyma (Figure 11) [56]. Cawich et al proposed a dichotomous typology of pons hepatis-incomplete (the liver fissure being incompletely covered by the liver parenchyma, <2 cm) and complete (the fissure is completely covered, >2 cm) [62]. The frequency of the hepatic bridge varies in the literature.…”

Section: Base Of the Round Ligament And The Hepatic Bridgementioning

confidence: 99%

Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery

Kostov,

Selçuk,

Watrowski

et al. 2024

Cancers

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Ovarian cancer (OC), the most lethal gynecological malignancy, usually presents in advanced stages. Characterized by peritoneal and lymphatic dissemination, OC necessitates a complex surgical approach usually involving the upper abdomen with the aim of achieving optimal cytoreduction without visible macroscopic disease (R0). Failures in optimal cytoreduction, essential for prognosis, often stem from overlooking anatomical neglected sites that harbor residual tumor. Concealed OC metastases may be found in anatomical locations such as the omental bursa; Morison’s pouch; the base of the round ligament and hepatic bridge; the splenic hilum; and suprarenal, retrocrural, cardiophrenic and inguinal lymph nodes. Hence, mastery of anatomy is crucial, given the necessity for maneuvers like liver mobilization, diaphragmatic peritonectomy and splenectomy, as well as dissection of suprarenal, celiac, and cardiophrenic lymph nodes in most cases. This article provides a meticulous anatomical description of neglected anatomical areas during OC surgery and describes surgical steps essential for the dissection of these “neglected” areas. This knowledge should equip clinicians with the tools needed for safe and complete cytoreduction in OC patients.

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Human liver umbilical fissure variants: pons hepatis (ligamentum teres tunnel)

Cited by 3 publications

References 31 publications

Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review

Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review

Trato Biliar: Variações Anatômicas E Sua Importância Na Prática Cirúrgica

Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery

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