Impact of Anatomical Variations of Right Hepatic Artery on Biliary Obstruction and Liver Fibrosis in Pediatric Congenital Biliary Dilatation Patients: A Retrospective Analysis of 1464 Cases.

BACKGROUND

The role of the ventrally positioned right hepatic artery (RHA) in congenital biliary dilatation (CBD) remains unclear.

METHODS

We retrospectively analyzed 1464 pediatric CBD patients undergoing surgery from 2015 to 2023, comparing those with ventrally positioned versus normal RHA.

RESULTS

Ventrally positioned RHA was identified in 10.31% of patients and was associated with more frequent symptoms (e.g., abdominal pain, vomiting, jaundice), elevated liver enzymes, and a higher incidence of liver fibrosis (23.40% vs. 14.85%, p = 0.008). It was an independent risk factor for fibrosis (adjusted OR = 1.74, p = 0.011) and correlated with increased bile duct strictures and intrahepatic duct dilation. No recurrence was observed during a 41-month median follow-up.

CONCLUSIONS

Ventrally positioned RHA contributes to biliary obstruction and liver fibrosis in pediatric CBD. Early recognition and surgical correction may improve outcomes and reduce long-term complications.