A Study of Confluence Pattern of Hepatic Ducts at Porta Hepatis and its Clinical Significance

Abstract

Introduction: The anatomy of the area surrounding the porta hepatis is fraught with variations which often do have a strong embryological basis. Usually the right and the left hepatic duct meet at the porta hepatis to form the common hepatic duct, however considerable difference exists with respect to the number of ducts forming the confluence and the site of the same. Aim: To examine the confluence pattern of the hepatic ducts at the porta hepatis and site of confluence of the ducts emerging from the liver to form the common hepatic duct. Presence of accessory/ aberrant ducts in the vicinity was also looked into. Materials and Methods: This study was carried out on one hundred liver specimens with intact extra hepatic biliary ductal system in the Department of Anatomy, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, and Department of Anatomy, Subharti Medical College, Meerut between the period of 2008 to 2013. Results: In 85 (85%) the usual mode of confluence i.e., the right hepatic duct and left hepatic duct joining to form the common hepatic duct was found. In 14 specimens (14%), the confluence was formed by three ducts and in one (1%), specimen by the union of four hepatic ducts. In one (1%) specimen though the confluence was formed by the right and left hepatic ducts, several small intrahepatic ducts emerged outside the liver to join the left hepatic duct. In 95(95%) specimens, the formation of common hepatic duct was extrahepatic and in five (5%) specimens it was intrahepatic. Six accessory ducts were also found in the study. Conclusion: Substantial variations were found in our study in the mode of confluence formation and site of confluence as well as presence of accessory ducts, the knowledge of which is of paramount importance for the surgeons in successful management of diverse invasive procedures, undertaken in this region.

Keywords

• accessory
• anatomy
• hilar
• tetrafurcation