[A "scandal": segment IV and liver transplantation]

Partition right-left lobes keeps segment IV in continuity with the right liver, but interrupts its portal elements which arise from the left portal pedicle. A precise anatomical investigation shows that the venous inflow is totally interrupted. In 12.15% of the cases (n = 107) the biliary duct from segment IV enters close to the upper biliary confluent, into the confluent or the main duct, and can be preserved in such a bipartition; in all other cases the segment is no longer in function and doomed to atrophy. In 10.75% of the livers (n = 99), the segmental artery comes from the right hepatic stem, and the segment is correctly vascularized; but in most cases interruption of both the artery and the portal branches leads to immediate necrosis, which may be lethal. Preservation of both artery and biliary ducts is possible in only 2.15% of the cases (n = 93 casts with correct injection of arteries and ducts). Consequently the partition right-left lobes is possible in only a few cases: cholangiography and arteriography detect the favourable dispositions. In all other cases such partition is forbidden. Procurement of the left lobe from a living donor with preservation of segment IV is rarely possible, such cases being detected by a thorough pre-operative vasculo-biliary investigation: the left lobe is harvested, and segment IV left in situ (2.15% of the cases). Usually the prospective of rapid necrosis or secondary atrophy commands resection of the segment.(ABSTRACT TRUNCATED AT 250 WORDS)