A comprehensive study and extensive review of morphological variations of liver with new insights.

PURPOSE: Liver is divided into four anatomical lobes presenting minor fissures and invisible major fissures. The prevalence of Accessory Fissures in liver ranges widely from 6 to 94%. The morphometric analysis of individual lobes is also scarce in literature. There have been instances where the surgeon has experienced some of these variations as a surprise during surgery as the existing data on the surface variations of liver is still contradictory. A sound knowledge of these variations would aid the surgeons and radiologists to circumvent the misdiagnosis and complications during surgeries.

METHODS: The study was conducted in 93 cadaveric livers. Minor liver fissures, Accessory fissures and lobes were noted and measured. The livers were classified according to the Netter's classification. The morphology of caudate and quadrate lobes was studied. Any other variations in the appearance of groove for Inferior vena cava, gall bladder and its fossa were also studied. The results are tabulated.

RESULTS: The study revealed several variations in the morphological features of liver. Accessory fissures were noted in 51.61% of livers, distributed on various liver surfaces. Accessory lobes were noted in 27.9%. Pons hepatis was present in 22.5%. Gall bladder variations that were noted include the Hartmann's pouch (n = 14; 15.05%) and the Phrygian cap (n = 2; 2.15%). 65.6% livers (n = 61) had the sulcus of the caudate process or fissure of Gans or Rouviere sulcus which is a normal fissure present in majority of normal healthy livers.

CONCLUSION: The current study provides a complete understanding and a thorough knowledge of surface morphological variations in liver. We hope that this will be greatly helpful for surgeons and radiologists to avoid possible errors in interpretations, to plan appropriately and assist during liver surgeries and to do radiological interventions.