Left hepatic duct anatomy: implications.

A review of the findings of a 10-year experience with biliary interventional procedures in 838 patients led to consideration of the anatomy of the left hepatic duct. To better illustrate the findings, 15 normal human livers obtained at autopsy were fixed and dissected. Fifty-five percent of the patients had a single left hepatic duct that was formed by the intrahepatic union of ducts draining segments II and III (segmental nomenclature follows Couinaud) lateral to the falciform ligament. Central to this ligament, the left duct became extrahepatic and was joined by ducts from segments I and IV. The real and theoretical implications of the unpredictable variability of biliary anatomy, the frequency of right lateral duct drainage into the left hepatic duct, and the extrahepatic contiguous relationship between the left hepatic duct and the left portal vein are discussed.