How to deal with hepatic artery injury during pancreaticoduodenectomy. A systematic review

SummaryBackgroundOperative injury to the hepatic artery is a serious complication of pancreaticoduodenectomy and guidelines to manage this complication are lacking.MethodsA systematic search performed in PubMed database identified eleven studies overall including 20 patients having sustained injury to the hepatic artery during pancreaticoduodenectomy (n = 18) or total pancreatectomy (n = 2). One further unpublished personal observation following pancreaticoduodenectomy was also included.ResultsSixteen of 21 patients (76%) experienced serious complications including liver necrosis/abscess (n = 14), acute liver failure (n = 3), and biliary anastomotic dehiscence (n = 6). Eleven patients (52%) were reoperated and 5 patients died (24%). Arterial injury was recognized and repaired immediately in five patients, four recovering uneventfully and one dying from acute liver failure (20%). In contrast delayed or conservative treatment in 16 patients was associated with serious early morbidity in 15 patients (94%), leading to death in 4 patients and late biliary complications in four others.ConclusionsAccidental interruption of arterial flow to the liver during pancreaticoduodenectomy often results in serious short and long-term consequences. Immediate restoration of arterial flow is indicated whenever technically feasible and may prevent early life-threatening complications as well as late biliary stenosis.