Laparoscopic detection of aberrant left hepatic artery: a prospective study in 300 consecutive patients

Laparoscopic gastric banding comprises the systematic section of the pars flaccida and condensa of the lesser omentum. Aberrant left hepatic arteries (ALHA) originating from the left gastric artery are located in the pars condensa of the lesser omentum. The aim of the present work was to study aberrant left hepatic artery rate in a prospective series of patients operated on for morbid obesity using laparoscopic gastric banding. Between October 2001 and December 2003, a monocentric prospective study of 300 consecutive patients operated on for morbid obesity was carried out. There were 245 women and 55 men with a mean age of 39±11 years. Preoperative weight was 123±18 kg, mean size was 166±9 cm and preoperative mean BMI was 44.5±5.6 kg m⁻² . Data were collected intraoperatively using a questionnaire submitted to the surgeon with patient and ALHA characteristics. The ALHA were detected in 102 patients (34%): one ALHA in 100 cases (98%) and two ALHA in two cases (2%). The ALHA diameter was estimated by comparison using laparoscopic instruments. The median ALHA diameter was 2 mm (0.5–13). A diameter ≥3 mm was observed in 47 patients (16%) and ≤1 mm in 23 patients (8%). The ALHA presence and/or size were not correlated with patient age, BMI or clinical characteristics. Using laparoscopic detection, ALHA rate (34%) was higher than in the main previously reported series. This higher ALHA rate was not related to the patient age, weight or BMI but seems to be due to the great sensitivity of this approach.