Living-donor hepatectomy in right-sided round-ligament liver: importance of mapping the anatomy to the left medial segment

Left-sided gallbladder (LSGB) and right-sided round ligament (RSRL) are very infrequent findings, mostly described in Oriental patients, that have associated anatomical variations. An abnormal portal vein branching, mainly to segment IV, is strongly associated with RSRL. Living-donor liver transplantation requires that both the graft and the remnant liver have adequate vascular supply and volumes. Abnormal vascularization of segment IV then threatens this goal. There have been scarce reports of the feasibility of living-donor hepatectomy under these conditions, all in Oriental populations. We present a case of an Occidental living liver donor with RSRL, and discuss the associated anatomical variations of the portal vascular supply of the liver, with its implications in planning a living-donor hepatectomy.