Abstract
BACKGROUND: A complete replacement left hepatic artery (LHA) solely originating from the left gastric artery (LGA), with no supply from the hepatic artery proper, is exceptionally rare. This variant places entire left lobe perfusion on the LGA. Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications. Unrecognized, this anatomy carries significant intraoperative injury risk during hepatobiliary/ upper gastrointestinal surgery. CASE SUMMARY: A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer. During dissection of the hepatogastric ligament, an unexpected vascular anatomy was encountered: The LHA originated exclusively from the LGA, with no conventional branch from the hepatic artery proper. Recognizing this variant artery was essential for left liver perfusion, the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA. The gastrectomy and reconstruction were completed without complication. Postoperative recovery was smooth, with serial liver function tests remaining normal, confirming preserved hepatic arterial supply. CONCLUSION: Preoperative mapping detected a critical aberrant left hepatic artery; its preservation prevented liver ischemia, ensured safety.