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Summary
Partitioning the right and left liver lobes is rarely feasible due to interrupted blood supply and bile ducts to segment IV. This anatomical complexity often leads to segment IV necrosis or atrophy, limiting surgical options.
Area of Science:
- Hepatobiliary surgery
- Surgical anatomy
- Liver transplantation
Context:
- Liver lobe partitioning, particularly right-left bipartition, presents significant anatomical challenges.
- Segment IV's vascular and biliary supply often originates from the left portal pedicle, complicating its preservation during right-left lobe division.
Purpose:
- To investigate the anatomical feasibility and risks associated with right-left liver lobe partitioning.
- To determine the frequency of anatomical variations that permit safe lobe bipartition with preservation of segment IV.
- To evaluate the potential for segment IV necrosis or atrophy following such partitions.
Summary:
- Precise anatomical investigation reveals that portal inflow to segment IV is frequently interrupted during right-left lobe partitioning.
- While biliary drainage from segment IV can be preserved in 12.15% of cases, vascular supply is compromised in most, leading to necrosis.
- Safe partitioning preserving both vasculature and biliary drainage for segment IV is possible in only 2.15% of cases, necessitating thorough pre-operative imaging.
Impact:
- Right-left liver lobe partitioning is feasible only in a small subset of patients, identified through detailed arteriography and cholangiography.
- Living donor left hepatectomy with segment IV preservation is rarely possible, often requiring segment IV resection due to necrosis risk.
- This study highlights the critical importance of pre-operative vasculo-biliary assessment to avoid catastrophic outcomes like necrosis or atrophy.