Vol. 21, N║ 1

TOPOGRAPHICAL RELATIONSHIPS AMONG THE PORTAL BRANCHES AND THE HEPATIC TRIBUTARIES IN THE LEFT LATERAL DIVISION OF THE LIVER OF BRAZILIAN INDIVIDUALS

JosÚ Roberto Ortale; JosÚ Meciano Filho; Mariana Ferreira de Rezende; Michelle Marchi de Medeiros

KEYWORDS: Hepatic, human, liver, morphology, portal, segment, vein

ABSTRACT: The left lateral division or left anatomical lobe of the liver is subdivided into posterior lateral or S2 and the anterior lateral or S3 segments. Because this lobe is widely used in hepatic transplantation, the ramifications of the portal vein and of the hepatic veins have been extensively studied. The aim of this study was to investigate the frequency of cases in which it is possible to delimit the S2 and S3 hepatic segments. Forty livers from Brazilian subjects of European and African descent were fixed in neutral formalin solution and dissected. In segment S2, there was always a portal branch located dorsally to the left hepatic tributary. In segment S3, there were three types of interdigitations distributed among two portal branches and two hepatic tributaries. In type A (26/40 cases, 65%), the tributaries crossed the dorsal portal branch posteriorly. In subtype A1 (19/26 cases), the tributaries pinched the ventral branch, and in subtype A2 (7/26 cases), they crossed the ventral branch posteriorly. In type B (11/40 cases, 27.5%), the two tributaries pinched the dorsal portal branch, with both pinching the ventral portal branch in subtype B1 (7/11 cases) but only the ventral tributary crossing the latter branch in subtype B2 (4/11 cases). In type C (3/40 cases, 7.5%), the ventral and dorsal tributaries crossed the dorsal portal branch anteriorly, with both vessels also crossing the ventral portal branch anteriorly in subtype C1 (2 cases) and only the ventral tributary crossing this branch in C2 (1 case). In all cases, it was possible to differentiate S2 from S3, even when in type C cases there was no hepatic tributary separating them. Moreover, in 23/40 cases (57.5%) there was a fissural umbilical vein greater than 5 mm in diameter and, in 5/23 cases this vein superficially crossed the portal branch destined to segment S3.