Preoperative detection and handling of aberrant right posterior sectoral hepatic duct during laparoscopic cholecystectomy

Abstract

It seems possible to identify most aberrant PHD by attention to the infraportal-type PHD, and injury to them can be avoided by exposing a critical view using an appropriate procedure.

Preoperative evaluation of accessory hepatic ducts by drip infusion cholangiography with CT

“…On the other hand, there have been few reports about the drainage areas of accessory hepatic ducts. It was reported that most accessory hepatic ducts (86.7–100%) are right posterior bile ducts [1, 6]. Hirao et al [7] found that of 13 patients with accessory hepatic ducts 9 (69%) had posterior ducts, two had anterior ducts (15%), one had an anteroinferior branch (8%), and a caudate branch was seen in the remaining patient (8%).…”

“…Of the various types of accessory hepatic ducts, type I, II, III, and IV ducts, which were observed in 32 (5.7%), 3 (0.5%), 1 (0.2%), and 11 patients (2.0%), respectively in this study, are at risk of bile duct injuries during the Calot triangle dissection. Especially, type IV ducts carry the greatest risk of bile duct injuries [1, 5, 6]. Noji et al [4] suggested that the installation of an endoscopic nasobiliary drainage tube prior to LC in cases involving predictable bile duct anomalies might reduce the incidence of complications, and Kurata et al [6] did that bile duct injuries can be avoided by using a surgical technique that exposes the inner layer of the subserosal layer of the gallbladder wall.…”

“…Especially, type IV ducts carry the greatest risk of bile duct injuries [1, 5, 6]. Noji et al [4] suggested that the installation of an endoscopic nasobiliary drainage tube prior to LC in cases involving predictable bile duct anomalies might reduce the incidence of complications, and Kurata et al [6] did that bile duct injuries can be avoided by using a surgical technique that exposes the inner layer of the subserosal layer of the gallbladder wall. We consider that intraoperative fluorescence cholangiography may be useful procedure to avoid bile duct injuries when patients with type I, II, III, or IV accessory hepatic ducts have severe inflammatory adhesion due to chronic cholecystitis.…”

Application of “three lines and one plane” as anatomic landmarks in laparoscopic surgery for bile duct stones

“…On the difficulty condition, such as the severe adhesions with the serosa of the posterior gallbladder, and the right hepatic pedicle, attentions are needed to avoid the injury of the anomalous cystic duct (origin from the trunk, or branch of right hepatic duct), [ 2 ] or accessory hepatic duct. [ 4 ]…”

Universal safe procedure of laparoscopic cholecystectomy standardized by exposing the inner layer of the subserosal layer (with video)

“…Therefore, detecting such an aberrant hepatic duct with a preoperative cholangiogram is important, for example, magnetic resonance cholangiopancreatography, even when the present standardized procedure will be performed. See a previous report regarding the frequency of aberrant hepatic ducts and how to detect them .…”