Lorenzo Cinelli1,2, Eric Felli3, Edoardo Maria Muttillo4, Guido Fiorentini5, Michele Diana2,6, Patrick Pessaux7, Emanuele Felli8. 1. IRCCS San Raffaele Scientific Institute, Milan, Italy. 2. Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France. 3. Hepatology, Department of Biomedical Research, Inselspital, Bern University, Bern, Switzerland. 4. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy. 5. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy. 6. University of Strasbourg, Strasbourg, France. 7. HPB Unit, Digestive Surgery Department, Nouvel Hopital Civil, University of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France. 8. HPB Unit, Digestive Surgery Department, Nouvel Hopital Civil, University of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France. emanuele.felli@chru-strasbourg.fr.
Abstract
PURPOSE: The hepato-mesenteric trunk is an extremely rare condition in which the common hepatic artery (CHA) originates from the superior mesenteric artery (SMA). Usually, CHA passes behind the head of the pancreas. A systematic review was performed to provide guidelines for the perioperative management of patients with this anatomical variation who underwent a pancreaticoduodenectomy (PD). A case report was also included. METHODS: A systematic search of the literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines. The risk of bias within individual studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools. Case report was structured according to the CARE guidelines. RESULTS: After an initial selection of 141 titles, 9 articles were included in the study (n = 10 patients). A postoperative surgical complication which required a reintervention occurred only one time. In four patients, CHA had a posterior position relative to pancreas, while in three cases, it was anterior. The remaining three patients had an intrapancreatic course. The CHA was resected in two patients, with an end-to-end reconstruction or using the splenic artery stump. In only three patients, a preoperative multidisciplinary presentation was performed and in four cases, the CHA variation was not described by radiologists in formal CT-scan reports. CONCLUSION: Although there are no definitive guidelines, improvements in the preoperative knowledge of such a rare anatomical variation may ensure better postoperative outcomes, avoiding intraoperative accidents and life-threatening postoperative complications.
PURPOSE: The hepato-mesenteric trunk is an extremely rare condition in which the common hepatic artery (CHA) originates from the superior mesenteric artery (SMA). Usually, CHA passes behind the head of the pancreas. A systematic review was performed to provide guidelines for the perioperative management of patients with this anatomical variation who underwent a pancreaticoduodenectomy (PD). A case report was also included. METHODS: A systematic search of the literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines. The risk of bias within individual studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools. Case report was structured according to the CARE guidelines. RESULTS: After an initial selection of 141 titles, 9 articles were included in the study (n = 10 patients). A postoperative surgical complication which required a reintervention occurred only one time. In four patients, CHA had a posterior position relative to pancreas, while in three cases, it was anterior. The remaining three patients had an intrapancreatic course. The CHA was resected in two patients, with an end-to-end reconstruction or using the splenic artery stump. In only three patients, a preoperative multidisciplinary presentation was performed and in four cases, the CHA variation was not described by radiologists in formal CT-scan reports. CONCLUSION: Although there are no definitive guidelines, improvements in the preoperative knowledge of such a rare anatomical variation may ensure better postoperative outcomes, avoiding intraoperative accidents and life-threatening postoperative complications.
Entities:
Keywords:
Case report; Common hepatic artery; Hepato-mesenteric trunk; Pancreaticoduodenectomy; Superior mesenteric artery; Systematic review
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