Liver morphology: anatomical study about the outer aspects

Hepatobilliary surgery is nowadays increasingly done throughout the world with advent of newer liver imaging modalities. Considering recent interest for accurate interpretation of different radiological images and performing surgical procedures, a precise understanding of hepatic surface anatomy is challenging due to high prevalence of previously identified morphological variations. Accordingly, a cadaveric study was attempted to revisit the morphological details of liver updating the unusual configurations along with their clinico-anatomical correlations and thus, compare the analysis of present study with previous published data.

We studied 110 formalin-fixed adult cadaveric livers of unknown age and sex having no pathological lesion or damage.

More than one morphological variation in combination was observed on repeated occasions in same liver specimen. The anatomical classification based on Netter's criteria was chosen in order to be coherent with previous studies to define different variations with addition of other subtypes. Accordingly, classical wedgeshaped livers were present in 57.3% specimens. Considering different morphological features, 78 (70.9%) variant livers were noted in terms of shape (as transverse saddle shaped, square shaped, globular, quadrilateral, pyriform or boot-shaped), altered numbers and position of fissures (affecting either one or more lobe in addition to absent fissure for ligamentum teres) or lobes (as aplasia, hypoplasia or hypertrophy) or processes (in addition to abnormalities of processes extending from caudate or quadrate lobe tongue-like process or appendix fibrosa hepatis or mini-accessory lobe) or impressions (as costal or variant visceral impressions affecting inferior surface) or evidence of pons hepatis(35.5%) orin combinations of all above.

Awareness of hepatic surface variation is worth knowing in successful planning of hepatobilliary surgeries with least complications.