281 Aberrant Right Hepatic Artery: A Common Anomaly Requiring Awareness During Laparoscopic Cholecystectomy

Abstract Background The aberrant right hepatic artery (ARHA) is a significant anatomical variation in hepatic vasculature, found in approximately 10-20% of the population. Laparoscopic Cholecystectomy is one of the indexed procedures required for certification in General Surgery, here we present 4 cases of laparoscopic cholecystectomy where we encountered ARHA to signify the awareness that it is not uncommon to encounter these variations intra operatively. Case There were 4 cases over 3 months operated by ST3 trainees under direct supervision, anomalies were detected intraoperatively after high suspicions of abnormally large, dilated vessel crossing cystic duct were made. Careful dissection of ARHA till liver insertion were done along with clipping of high origin of cystic artery. The rest of surgery and recovery was uneventful. Post-surgery CT Angiogram were organized to delineate anatomy of vessel for future reference. Discussion This arterial anomaly originates from the superior mesenteric artery rather than the common hepatic artery, deviating from the typical arterial supply of the liver. We encountered 2 cases where the artery was having its course medially and 2 cases from inferior aspect of the hilum. Clinically, the presence of an ARHA holds considerable importance, especially in hepatobiliary and pancreatic surgeries, liver transplantations, and interventional radiology procedures, where unrecognized variants can lead to complications such as ischemia, haemorrhage, and postoperative liver dysfunction. Conclusions ARHA represents a vital anatomical variant with implications interventional outcomes. Recognition of ARHA through imaging and meticulous operative planning is essential for minimizing intraoperative complications and ensuring optimal patient outcomes in hepatobiliary care.