Left‐sided gallbladder: a systematic review of a rare biliary anomaly

Abstract

Background A left‐sided gallbladder (LSGB) is a rare anatomical anomaly that is often not discovered until surgery. Two cases of LSGB managed with laparoscopic cholecystectomy (LC) stimulated this systematic review. The aims of this study were in LSGB to define the rate of pre‐operative detection, variations in biliary anatomy, laparoscopic techniques employed and outcomes of surgery for symptomatic gallstones. Methods A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta‐Analyses principles. Results Fifty‐three studies with 112 patients of which 90 (80.4%) had symptomatic gallstones. Pre‐operative imaging was performed in 108 patients (96.4%) with an LSGB reported on imaging in 32 (29.6%) patients. The remainder of LSGB were discovered at surgery. Ultrasound detected an LSGB in three (2.7%) patients. Five variants of cystic union with the common hepatic duct (CHD) were identified. The most common (67.8%) was union on the right side of the CHD after a hairpin bend anterior to the CHD. A cholecystectomy for gallstone disease was performed in 90 patients, 23.3% open and 76.7% LC. Common variations in LC technique were different port site placement and techniques related to the falciform ligament to improve exposure. Common bile duct injury occurred in four (4.4%) patients. Conclusion LSGB is a rare anatomical variation that in patients with symptomatic gallstones is usually discovered at surgery. Cholecystectomy is associated with a higher incidence of common bile duct injury.

Surgical approach to a left-sided gallbladder

“…As described in our present case, LSGB is frequently overlooked on preoperative ultrasound, the most common imaging modality for symptomatic gallstone disease 6. The positive predictive value of ultrasound-detected LSGB is a mere 2.7% 6.…”

“…The positive predictive value of ultrasound-detected LSGB is a mere 2.7% 6. Most patients with symptomatic gallstones do not require other forms of cross-sectional imaging (CT or MRI), which have a higher detection rate for LSGB and thus the aberrant anatomy is generally encountered unexpectedly at the time of surgery as we have reported 6…”

“…In 1886, Hochstetter first described a small series of LSGB and subsequently, the accepted definition is a gallbladder left of the round ligament, attached to the undersurface of segment 3 without situs inversus viscerum 6 8. This rare anatomical variation of the extra-hepatic biliary anatomy is most frequently reported in patients having cholecystectomy for symptomatic gallstones 6…”

“…A left-sided gallbladder (LSGB) is a rare biliary anomaly generally reported in patients having cholecystectomy for symptomatic gallstones 67.…”

“…Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones 7. In patients with LSGB, LC is associated with a higher incidence of bile duct injury (4.4%), necessitating the establishment of a safe surgical approach in these patients 6…”