Magnetic resonance and retrograde endoscopic cholangiopancreatography-based identification of biliary tree variants: are there type-related variabilities among the Saudi population?

Al-Muhanna, Asma Fahd; Lutfi, Abdelhamied Mohamed; Al-Abdulwahhab, Abdulrahman Hamad; Al-Sharydah, Abdulaziz Mohammad; Al-Quorain, Abdulaziz; Almuhanna, Afnan F; Al-Dhaferi, Bander Fuhaid

doi:10.1007/s00276-019-02249-0

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…Such findings were also reported in a study of MRCP in 1,011 inhabitants of the Aegean region of Turkey ( 23 ). However, in a study report of 150 Saudi Arabian population, no gender difference was detected ( 24 ). Similarly, in our study, Fisher's accurate test showed no significant correlation between the anatomic variations of the biliary tract and gender ( P > 0.05).…”

Section: Discussionmentioning

confidence: 95%

“…Among the variant types, the right posterior hepatic duct (RPHD) drainage to the LHD (type III) was the most common, noted in about 9.3% to 28.7%. The so-called “trifurcation pattern” (type II) is the second most common, noted in about 9%–19%, and the insertion of the RPHD into the CHD or CD is the least common ( 4 – 6 , 21 , 23 , 24 ). The Hisense CAS system analysis results showed that type I accounted for 54%, which was the typical biliary anatomical structure, types II and III were the most common variant types, accounting for 10% and 14% respectively, and types IV and V were the least common variant types, accounting for 10% and 2% respectively; these findings were similar to earlier literature reports ( 4 – 6 , 21 , 23 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…The so-called “trifurcation pattern” (type II) is the second most common, noted in about 9%–19%, and the insertion of the RPHD into the CHD or CD is the least common ( 4 – 6 , 21 , 23 , 24 ). The Hisense CAS system analysis results showed that type I accounted for 54%, which was the typical biliary anatomical structure, types II and III were the most common variant types, accounting for 10% and 14% respectively, and types IV and V were the least common variant types, accounting for 10% and 2% respectively; these findings were similar to earlier literature reports ( 4 – 6 , 21 , 23 , 24 ). In addition, we were surprised to note that some of the specific biliary tract types could not be explained according to the Huang classification.…”

Section: Discussionmentioning

confidence: 99%

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Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population

Duan

et al. 2022

Front. Surg.

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This study aimed to establish three-dimensional models of the biliary tract of Chinese people using the Hisense computer-aided surgery (CAS) system and to explore the branching patterns and variation types of the biliary system under the study of 3D reconstruction of the biliary tract. Three-dimensional models of the biliary tract were reconstructed in 50 patients using the Hisense CAS system. The branching patterns of intrahepatic bile ducts were observed. The biliary tract was classified according to the confluence of the right posterior sectoral duct (RPSD), right anterior sectoral duct (RASD) and left hepatic duct (LHD), and the presence or absence of accessory hepatic ducts. The 3D models of the bile ducts were successfully reconstructed in 50 Chinese patients. The branching patterns of the bile ducts were classified into seven types. The anatomy of the bile ducts was typical in 54% of cases (n = 27), showed triple confluence in 10% (n = 5), and crossover anomaly in 14% (n = 7), which means anomalous drainage of the RPSD into the LHD, anomalous drainage of the RPSD into the common hepatic duct (CHD) in 10% (n = 5), anomalous drainage of the RPSD into the cystic duct (CD) in 2% (n = 1), absence of left main hepatic duct in 1% (n = 1), presence of accessory duct in 8% (n = 4). Among them, there were three cases of accessory hepatic ducts coexisting with other variation types. By using the Hisense CAS system to establish 3D models of the biliary tract of the Chinese people, we established the branching model of the second-order bile ducts, which has important value for the classification of the biliary system and its variation types.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population

Duan

et al. 2022

Front. Surg.

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“…It was variously described as “kinked,” “bassinet‐shaped,” “sharply flexed on itself,” “S‐shaped,” and “double mesial curved” in the earlier literature (Mentzer, 1926). Previous classifications of cystic duct configurations have identified three main types: a normal angular cystic duct (of about 40°, 64%–75%), a spiral type crossing in front of or behind the BD (8%–13%), and a parallel type running parallel to the BD (4%–23%) (Al‐Muhanna et al, 2019; Kubota et al, 1993; Newman & Northup, 1963; Shaw et al, 1993; Turner & Fulcher, 2001). In the present study, the configuration showed many variations.…”

Section: Discussionmentioning

confidence: 99%

The anatomy of the cystic duct and its association with cholelithiasis: MR cholangiopancreatographic study

et al. 2022

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The aims of this article are to detail the anatomy of the cystic duct in patients with and without gallstones as it relates to maneuvering of the duct during endoscopic transpapillary gallbladder cannulation, and to elucidate its role in the dynamics of bile flow during gallbladder contraction. One hundred MRCPs were retrieved from the prospectively maintained radiology data system to assess the configuration of the cystic duct and its confluence vis-a-vis the main biliary duct. The configuration of the cystic duct was broadly classified into four types: Angular (44%), Linear (40%), Spiral (11%), and Complex (5%). The level of emergence of the cystic duct from the bile duct was proximal in 29%, middle in 49% and distal in 20%. Its direction from the bile duct was to the right and angled upward in 69%, right and angled downward in 15%, left and angled upward in 13%, and left and angled downward in 1%. Its orifice was on the lateral surface of the bile duct in 50%, posterior in 19%, anterior in 15% and medial in 14%. In two cases, the cystic duct opened directly into the duodenum.Tortuous cystic ducts and non-lateral unions with the bile duct were significantly more prevalent in gallstone cases than the non-gallstone group (p = 0.02). The present study details the spatial anatomy of the cystic duct vis a vis the main biliary duct. This has not been well investigated to date but has become increasingly relevant with the advent of recent gallbladder interventions.

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“…As a result, the liberal use of pre-operative magnetic resonance cholangiopancreatography (MRCP) is gaining popularity as a roadmap prior to cholecystectomy, aiming to assess primarily for the presence of migrated gallstones within the cystic duct or common bile duct, as well as providing information regarding the anatomical features of the extrahepatic biliary tree on an individualised basis [ 4 – 6 ]. Although the examination is accompanied by an increase in the healthcare-associated costs, the performance of the pre-operative cholangiopancreatography and its correct interpretation enables, particularly, non-hepatobiliary surgeons to tailor the management of cases with increased complexity, such as patients with Mirizzi’s syndrome, or cases with concurrent extrahepatic bile duct lithiasis that would usually require clearance through endoscopic retrograde cholangiopancreatography (ERCP) prior to cholecystectomy [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Routine extensive dissection of the cystic duct during laparoscopic cholecystectomy to reduce the risk of residual choledocholithiasis: an unnecessary step and a potentially hazardous concept

Seretis¹,

Zohdy²,

Padgett³

et al. 2022

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Introduction Post-cholecystectomy choledocholithiasis can occur from retained stones at the cystic duct stump remnant; however, most surgeons would not proceed with extensive dissection of the cystic duct during routine cholecystectomy, mainly in fear of inadvertent bile duct injuries, given the frequent anatomical variations of the extrahepatic biliary tree. Aim To determine the need and feasibility of extensive dissection of the cystic duct during laparoscopic cholecystectomy, to reduce the risk of post-cholecystectomy choledocholithiasis. Material and methods We performed a retrospective review of our institutional database of all patients who had magnetic resonance cholangiopancreatography (MRCP) prior to cholecystectomy over a 3-year period (03/2016-04/2019), assessing the anatomical variations of the cystic duct and the incidence of cystic duct stones. Results During the study period, from a total of 763 patients who underwent cholecystectomy for symptomatic gallstones, 284 had undergone pre-operative MRCP and were all included in the final analysis. The typical right lateral insertion of the cystic duct in the midpoint between the confluence of the main hepatic ducts and the ampulla of Vater was identified in less than 50% of the patients. In our series, cystic duct stones were present only in 1.8% of our patients. Conclusions The presence of significant anatomical variations and the low likelihood of incidental cystic duct stones render prophylactic extensive dissection of the cystic duct during standard laparoscopic cholecystectomy a rather unnecessary and probably hazardous step.

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Magnetic resonance and retrograde endoscopic cholangiopancreatography-based identification of biliary tree variants: are there type-related variabilities among the Saudi population?

Cited by 8 publications

References 21 publications

Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population

Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population

The anatomy of the cystic duct and its association with cholelithiasis: MR cholangiopancreatographic study

Routine extensive dissection of the cystic duct during laparoscopic cholecystectomy to reduce the risk of residual choledocholithiasis: an unnecessary step and a potentially hazardous concept

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