Biliary anatomy

Substituents attached to the phenyl ring affect the degree of hepatic uptake and the rate of excretion, as well as urinary elimination of the Tc-IDA complex (Nunn et al. 1983). Approximately 82% of the injected dose of Tc-EHIDA, 88% of Tc-disofenin, and 98% of " Tc-mebrofenin are extracted by the hepatocytes and secreted into bile with a hepatic excretion half-time of 37.3, 19.0, and 17.0 min, respectively (Krishnamurthy and Krishnamurthy 1989 Krishnamurthy and Turner 1990). Clinical comparison of diethyl-IDA (etifenin) and diisopropyl-IDA (disofenin) was also reported (Klingensmith et al. 1981). Tc-DISIDA and Tc-mebrofenin show least hepatic retention and are best suited to delineate hepatic biliary anatomy (Krishnamurthy and Krishnamurthy 1989). 

Although conventional vascular and biliary anatomy have been described, there are many variants which maybe present more or less often. 

Chu WC, Yeung DT, Lee KH et al (2005) Feasibility of morphologic assessment of vascular and biliary anatomy in pediatric liver transplantation all-in-one protocol with breath-hold magnetic resonance. J Pediatr Surg 40 1605-1611... 

Couinaud C. Liver anatomy portal (and suprahepatic) or biliary segmentation. Dig Surg 1999 16 459-467. 

Ludwig, J., Ritman, E.L., LaRusso, N.F., Sheedy, P.F., Zump, G. Anatomy of the human biliary system studied by quantitative computer-aided three-dimensional imaging techniques. Hepatology 1998 27 893-899... 

Finally, an intraoperative cholangiogram will finally depict the anatomy of the biliary ducts and will assess whether the main right and left hepatic ducts have the caliber necessary to perform the Kasai hepatic portoenterostomy (Gazelle et al. 1998) (Fig. 4.2e). 

Healy JE, Schroy PC (1953) Anatomy of the biliary ducts within the human liver analysis of prevailing pattern of branchings and major variations of the biliary ducts. Arch Surg 66 599-619... 

Knowledge of segmental anatomy and interseg-mental biliary connections is an essential prerequisite to the effective management of patients with complex bile duct anatomy (e.g., congenital abnormalities, bilio-enteric anastomoses). Three-dimensional imaging techniques are also very useful for an accurate anatomical assessment before surgery. 

In fact, VR is the latest development for 3D visualization of the anatomy of the biliary tree (Kondo et al. 2001 Neri et al. 2000 Wielopolski et al. 1999). This method allows one to simultaneously display different anatomical structures imaged within a single volume. It provides an image created by simulated rays of light, arising from a virtual source (i.e., the eye of the user look-... 

Direct cholangiography is anyway the best method for detailed anatomy of the biliary tract, often showing aberrant entry of the common bile duct into the side of the pancreatic duct. 

Preoperative imaging should evaluate the liver parenchyma, depict the relevant vascular anatomy and measure the total and lobar volumes (Kruskal and Raptopoulos 2002). Exclusion of parenchymal, vascular, and biliary abnormalities or variations that could increase surgical morbidity for partial hepatectomy is a primary concern. 

Smadja C, Blumgart LH (1994) The biliary tract and the anatomy of biliary exposure. In Blumgart LH (ed) Surgery of the liver and biliary tract, 2nd edn. Churchill Livingstone, London... 

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