Laparoscopic fundoplication and the aberrant left hepatic artery

The aberrant left hepatic artery is a frequently encountered anomaly found during laparoscopic fundoplication. The incidence of this anomaly in textbooks of surgery and anatomy is often cited as 25%. However, in our experience it occurs in only 6.5% of patients; preponderantly in females. The presence of an aberrant left hepatic artery complicates the dissection at the esophageal hiatus. This artery should be identified and isolated without being injured or divided. As documented in our series, the operation can be safely completed leaving this artery intact.