Hepatic venous drainage : are we Sri Lankans different from rest of the world ?

Abstract

OBJECTIVES : As there is no documented study for the Sri Lankan population, our study was mainly aimed at re-evaluating the hepatic venous drainage. DESIGN,SETTING AND METHODS : Seventy five non selected fresh adult cadavers (within 24 hours of death) were dissected. Those with crush injuries to the liver, abdominal scars or previous hepatobiliary surgery were excluded. Findings were documented according to a standard proforma. All abnormalities were photographed, RESULTS : Male to female ratio was 65 : 10. All three communities were represented in the study (Sinhalese:Tamil,Muslim - 63:3:2). Mean age was 49 years (range 18-81). Normal pattern of hepatic venous drainage as given in the text books was not seen in any of the cadavers. Altogether 70 (93.3%) cadavers revealed major abnormalities. Most striking abnormality was a separate vein draining the caudate lobe directly into the JVC in 47 (62.8%) cadavers. CONCLUSION : Our study indicates that the surgeon should not expect the "normal anatomy" when dealing with hepatic veins. Since the majority of our patients had a separate vein draining the caudate lobe directly into the IVC, this may be considered the norm rather than a variation. Whether it is found only in our population can only be confirmed by conducting multi ethnic and multi national studies.vOBJECTIVES : As there is no documented study for the Sri Lankan population, our study was mainly aimed at re-evaluating the hepatic venous drainage. DESIGN,SETTING AND METHODS : Seventy five non selected fresh adult cadavers (within 24 hours of death) were dissected. Those with crush injuries to the liver, abdominal scars or previous hepatobiliary surgery were excluded. Findings were documented according to a standard proforma. All abnormalities were photographed, RESULTS : Male to female ratio was 65 : 10. All three communities were represented in the study (Sinhalese:Tamil,Muslim - 63:3:2). Mean age was 49 years (range 18-81). Normal pattern of hepatic venous drainage as given in the text books was not seen in any of the cadavers. Altogether 70 (93.3%) cadavers revealed major abnormalities. Most striking abnormality was a separate vein draining the caudate lobe directly into the JVC in 47 (62.8%) cadavers. CONCLUSION : Our study indicates that the surgeon should not expect the "normal anatomy" when dealing with hepatic veins. Since the majority of our patients had a separate vein draining the caudate lobe directly into the IVC, this may be considered the norm rather than a variation. Whether it is found only in our population can only be confirmed by conducting multi ethnic and multi national studies.