Anatomical variations of cystic artery, cystic duct, and gall bladder and their associated intraoperative and postoperative complications: an observational study

Abstract

Background: Anatomical variations in the calots triangle encountered during laparoscopic cholecystectomy are not uncommon. Misidentification and misperception of these structures are the major cause of vasculobiliary injuries. This study was conducted to estimate the prevalence of anatomical variations of the cystic artery, cystic duct (CD), and gall bladder. This is the first study in India to access the rate of intraoperative and postoperative complications in anatomical variants compared to normal individuals. Patients and methods: It was a prospective observational study on patients undergoing laparoscopic cholecystectomy in the department of General Surgery at the tertiary center of India. The calculated sample size was 298. Variations of the cystic artery, CD, and gall bladder along with intraoperative and postoperative complications were noted. The comparative analysis of intraoperative and postoperative complications and a subgroup analysis between anatomical variants and normal patients were performed. Results: The most common variations were found in cystic arteries (16.8%). CD anomalies were present in 11.4% of patients, and gall bladder anomalies were the least common of all (5.4%). Intraoperative and postoperative complications were compared between patients with anatomical variations and normal anatomy. Intraoperative complications in patients with anatomical variations were significantly higher. Bile leak (15.7% vs. 6.4%) (P=0.01), haemorrhage (16.8% vs. 1.9%) (P-value <0.001), conversion to open (3 vs. 0 patients) (P-value =0.03). Subgroup analysis revealed a strong association between intraoperative haemorrhage and bile leak with cystic artery and CD anomalies, respectively. Conclusion: Cystic artery anomalies are the most common variations. Patients with anatomical variations had significant intraoperative and postoperative complications compared to patients with normal anatomy.

Assessment of Congenital Anomalies Encountered During Laparoscopic Cholecystectomy

“…Gallbladder Anomalies Common hepatic artery anomalies (8.39%) followed by cystic duct anomalies (3.49%) right hepatic duct anomaly (2.79%), gall bladder anomalies (2.9%), and least common was presence of common hepatic artery (1.39%). Consistently Gupta R et al 22 reported that the most common variations were found in cystic arteries, accounting for 16.8% of cases. Anomalies in the CD were detected in 11.4% of cases, while anomalies in the gall bladder were the least frequent, occurring in only 5.4% of cases.…”

Unusual Anatomic Variant of the Biliary Tree

“…Among these variations, the presence of Luschka ducts, also known as subvesical ducts, alongside an aberrant right hepatic duct, represents a particularly infrequent occurrence [2]. This unique combination presents a surgical conundrum and is an important risk factor for biliary surgical lesions during cholecystectomy [3].…”

“…During this procedure, an anatomical anomaly was discovered, consisting of a 3 mm aberrant right hepatic duct draining into the cystic duct, accompanied by three 1 mm subvesicular ducts connecting to the common hepatic duct. A thorough understanding of anatomical variations is essential for assessing the practicality of surgical procedures and executing surgeries in this area without complications [3].…”