Anatomical Variations in Arrangement of Renal Hilar Structures and its Applied Importance: A Cadaveric Cross-sectional Study among North East Population of India

Autor: Mousumee Saikia, Rajat Dutta Roy, Santona Thakuria
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: International Journal of Anatomy Radiology and Surgery, Vol 13, Iss 5, Pp AO05-AO09 (2024)
Druh dokumentu: article
ISSN: 2277-8543
2455-6874
DOI: 10.7860/IJARS/2024/73168.3009
Popis: Introduction: The hilum of the kidney leads into a central renal sinus filled with the renal pelvis and renal vessels. The classical arrangement of the structures present is the renal vein, renal artery, and renal pelvis, from anterior to posterior. Previous studies have shown many variations in the arrangement of the structures in the renal hilum; however, there is a lack of literature on this topic in the North-east region of India, where many communities and tribes reside. Aim: To evaluate both the classical and anatomical variations in the arrangement of the renal hilar structures in human cadavers. Materials and Methods: The present study was a cadaveric cross-sectional study conducted in the Department of Anatomy at Assam Medical College, Assam, India, involving 160 specimens from 80 cadavers, both adult and foetal (≥36 weeks), from July 2013 to June 2014. Among these, 15 were adult cadavers and 65 were perinatal cadavers (11 male and 4 female adults; 28 male and 37 female perinates). The relations of the structures, i.e., renal artery, renal vein, and renal pelvis present in the renal hilum, were studied in an anterior-posterior manner after meticulous dissection. Results: In the present study, the majority of specimens exhibited hilar structures arranged in a VAP pattern (67 kidneys, 41.88%), with a higher occurrence on the left-side (37 kidneys, 23.1%) compared to the right-side (30 kidneys, 18.7%). This was followed by a VAPA pattern (28 kidneys, 17.5%). Variations in the arrangement of hilar structures other than the classical arrangement were observed in more than 59% (93 kidneys) of the specimens. It was noted that the anterior and posterior divisions of the renal artery and the anterior and posterior tributaries of the renal vein occupied the pre-hilar and hilar regions rather than the main trunks. Conclusion: It was observed that the arrangement of the structures present in the renal hilum exhibits a wide spectrum of variations. Knowledge of these variations may be beneficial not only for anatomists but also for urologists and radiologists, as it may help prevent or at least minimise the incidence of intraoperative injuries and post-operative complications. Urological procedures such as nephrectomy and renal transplant operations require careful dissection and separate ligation of the renal vessels present in the renal hilum to prevent arteriovenous fistula and massive haemorrhage. Prior knowledge of unusual arrangements of the hilar structures may assist surgeons in avoiding inadequate ligation of vessels and minimising complications.
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