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Liver

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Surgery

Abstract

The liver is approximately 4% to 5% of the total body weight and has multiple complex functions. The anatomy of the liver (Fig. 30.1) has been described using various methods1–5; however, surgical anatomy is based on the segmental nature of vascular and bile duct distribution. The liver receives a dual blood supply from both the portal vein and the hepatic artery, which run, along with the bile duct, within the Glissonian sheath or main portal pedicle. The portal pedicle divides into right and left branches and then supplies the liver in a segmental fashion. Venous drainage is via the hepatic veins, which drain directly into the inferior vena cava. Hepatic segmentation is based on the distribution of the portal pedicles and their relation to the hepatic veins (Fig. 30.1). The three hepatic veins run in the portal scissurae and divide the liver into four sectors, which are in turn divided by the portal pedicles running in the hepatic scissurae. The liver is divided into right and left hemilivers by the middle hepatic vein. The right hemiliver is divided by the right hepatic vein into anterior and posterior sectors. The anterior sector is divided by the plane of the portal pedicle into an inferior segment (V) and a superior segment (VIII) (see Fig. 30.1). The posterior sector is divided by the plane of the portal pcdicle into an inferior segment (VI) and a superior segment (VII). The left hemiliver lies to the left of the middle hepatic vein and is divided into anterior and posterior sectors by the left hepatic vein. The anterior sector is divided by the umbilical fissure into segment IV medially and segment III laterally. The segment posterior to the left hepatic vein is segment II. Segment IV can be divided by the plane of the portal pedicle into a superior segment (IVa) and an inferior segment (IVb). Segment I is the caudate lobe, which lies between the inferior vena cava and the hepatic veins. The caudate lobe has variable portal venous, hepatic arterial, and biliary anatomy and is essentially independent of the portal pedicle divisions and hepatic venous drainage. Segmental anatomy becomes important in considering surgical resection when essentially any segment or combination of segments can be resected if attention is paid to maintaining vascular and biliary continuity to remaining segments.

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Authors
  1. Alan Hemming
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  2. Steven Gallinger
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Editor information

Editors and Affiliations

  1. University of California, San Francisco, USA

    Jeffrey A. Norton MD (Professor and Vice-Chairman of Surgery, Chief) (Professor and Vice-Chairman of Surgery, Chief)

  2. Surgical Service, San Francisco VA Medical Center, San Francisco, California, USA

    Jeffrey A. Norton MD (Professor and Vice-Chairman of Surgery, Chief) (Professor and Vice-Chairman of Surgery, Chief)

  3. Division of General Surgery, Duke University Medical Center, Durham, North Carolina, USA

    R. Randal Bollinger MD, PhD (Professor of Surgery, Professor of Immunology, Chief) (Professor of Surgery, Professor of Immunology, Chief)

  4. Division of Surgical Oncology, University of Michigan, Comprehensive Cancer Center, Ann Arbor, Michigan, USA

    Alfred E. Chang MD (Chief, Hugh Cabot Professor of Surgery) (Chief, Hugh Cabot Professor of Surgery)

  5. Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA

    Stephen F. Lowry MD (Professor and Chairman) (Professor and Chairman)

  6. Division of General Surgery, University of California, San Francisco, San Francisco, California, USA

    Sean J. Mulvihill MD (Professor of Surgery, Chief) (Professor of Surgery, Chief)

  7. Karmanos Cancer Institute, Wayne State University, Harper Hospital, Detroit, Michigan, USA

    Harvey I. Pass MD (Professor of Surgery and Oncology, Chief of Thoracic Oncology) (Professor of Surgery and Oncology, Chief of Thoracic Oncology)

  8. Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri, USA

    Robert W. Thompson MD (Associate Professor of Surgery) (Associate Professor of Surgery)

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© 2001 Springer Science+Business Media New York

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Hemming, A., Gallinger, S. (2001). Liver. In: Norton, J.A., et al. Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-57282-1_30

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  • DOI: https://doi.org/10.1007/978-3-642-57282-1_30

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63239-6

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