The porta hepatis is a deep, transverse fissure found on the central aspect of the visceral surface. It serves as a gateway, as various neurovascular structures and hepatic ducts enter and exit the liver through the porta hepatis. It is also known as the transverse hepatic fissure or the hilum of the liver.

The major structures entering the porta hepatis include the main hepatic portal vein (Read more!; it bifurcates into the right and left hepatic veins at the hilum of the liver) and the left and right hepatic arteries (the proper hepatic artery (Read more!) bifurcates into the left and right hepatic arteries at the hilum of the liver), as well as the hepatic nervous plexuses (Read more!). In contrast, the right and left hepatic ducts (Read more!) and lymphatic vessels leave the liver through the porta hepatis.

From posterior to anterior, the porta hepatis has the portal vein, the right and left hepatic arteries and the right and left hepatic ducts (VAD - vein, arteries, ducts). Therefore, from all the mentioned structures, the hepatic ducts are more accessible during surgeries. Besides the mentioned structures, some lymph nodes are also found at the porta hepatis.

Overall, the porta hepatis is bounded by all the anatomical lobes of the liver and the gallbladder fossa. The porta hepatis is a non-peritoneal structure, meaning it is not covered by the visceral peritoneum. Additionally, it provides attachment for the lesser omentum.

Portal triad

The main hepatic portal vein, proper hepatic artery, and common bile duct are often referred to as portal triad. They approach the porta hepatis by traveling within the hepatoduodenal ligament.

The hepatoduodenal ligament and portal triad is located anterior to the omental foramen (epiploic foramen or foramen of Winslow) - the only natural opening to the lesser sac (omental bursa). Directly posterior to the omental foramen is the inferior vena cava.

If there is bleeding from the liver during surgery, it can be reduced and controlled by the Pringle maneuver. It is a manual occlusion of the hepatoduodenal ligament, during which structures within the hepatoduodenal ligament are clamped to interrupt blood flow to the liver. It helps reduce blood loss and also reduces the need for perioperative blood transfusions.

Note: Due to the presence of a relatively large number of various important structures in one small area, the porta hepatis is a region of surgical and radiological significance. While the mentioned structures are usually arranged in a particular order, it is important to have the knowledge of possible variations, as it can reduce the risk of iatrogenic complications during hepatobiliary surgeries.

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Porta hepatis