Identification landmark for right anterior portal pedicle: "the zone of 2 cm"
Houssem Ammar1, Mohamed Azzaza2, Rahul Gupta3
1Department of Surgery, Hospital Ibn Jazzar, Kairouan, 3100, Tunisia. hosshoss24@hotmail.fr.
Purpose/Background:
Cystic plate is easily visible while right anterior portal pedicle (RAPP) is a difficult to identify due to its intrahepatic location. This study aims to determine the relation between these two structures so as to facilitate rapid identification of RAPP during the operation.
Methods:
Thirty-seven cadaveric liver dissections were carried in the Forensic Department at the Charles Nicolle Hospital, Tunisia.
Results:
The cystic plate was thin (≤1 mm), medium (1-3 mm), and thick (≥3 mm) in 14 (37.8%), 17 (46%), and 6 cases (16.2%), respectively. RAPP was found to be originating from right, main, and left portal trunk in 29 (78.3%), 6 (16.3%), and 2 (5.4%) livers, respectively. The origin of RAPP was extrahepatic in nine cases (24.3%). RAPP was located underneath the cystic plate in 21 livers (56.8%). Thirteen RAPPs (35.1%) were located to its right at the mean distance of 1.4 cm (range 0.4-2.5). Three RAPPs were present to the left of cystic plate (8.1%) at the mean distance of 0.9 cm (range 0.7-1.3).
Conclusion:
Rapid identification of RAPP is possible by knowing its anatomic variations and its relation with cystic plate.
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