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.