Anatomic Variations of Extrahepatic Bile Ducts and Evaluation of the Length of Ducts Composing the Cystohepatic Triangle

Abstract

SUMMARY:It is of paramount importance for surgeons to have a thorough knowledge of the normal anatomy of the extrahepatic bile ducts and its variations due to the high frequency with which they perform in this anatomic site. The cystohepatic triangle, or Calot's Triangle, is bound by the cystic duct, common hepatic duct, and the hepatic border; therefore, its surface area depends on the conformation of these ducts and is closely linked to surgical procedures performed in this region. It has been reported that the length and the position of these ducts may be related to the formation of bile duct stones, Mirizzi's syndrome, and bile duct cancer. Thus, the present work aims to analyze the configuration of the extrahepatic biliary tree and its possible variations, as well as measure the components that make up the cystohepatic triangle. For this task 41 samples from fixated human cadavers were analyzed, with 25 consisting of anatomic parts (liver and biliary tree) and 16 in situ samples. The extrahepatic biliary trees were dissected in order to measure the length of the common hepatic and cystic ducts with a digital caliper, and all anatomic variations were registered. The length of the common hepatic duct varied between 4.18 mm and 50.64 mm, with an average of 21.76 ± 9.51 mm. The length of the cystic duct varied between 7.28 and 38.88 mm, with an average of 19.11 ± 6.77 mm. Anatomic variations were found in 3 samples (7.3%): in one of them the cystic duct connected to the left hepatic duct; in another, the cystic duct connected to the right hepatic duct; in the third, there was a triple confluence of hepatic ducts (two right ducts and one left duct). The results are a contribution to the clinical and surgical anatomy of this region.

Cystic Duct Opening into Right Hepatic Duct; a Disaster Waiting to Happen During Cholecystectomy: A Case Report

“…Rarely there may be complete absence or duplication of cystic duct. The long ducts are more prone to injuries, Pancreatitis, Mirizzi's syndrome and stone formation [3]. Although CT, MRI (magnetic resonance imaging), MRCP, ERCP and helical CT scan have improved the preoperative diagnostic yield of biliary tract anomalies but they are not done routinely.…”

“…Right hepatic duct can be mistaken for cystic duct, ligated and divided. The patient may present with biliary peritonitis, biliary fistula or cirrhosis of the liver at a later stage [3]. Even the greatest of the surgeons can make errors, leave aside the beginners.…”

Variações anatômicas nas vias biliares presentes em intervenções cirúrgicas

“…As variações anatômicas, nos ductos cístico e hepáticos, são de grande desafio para os cirurgiões, uma vez que a ausência do conhecimento imediato da desembocadura ou morfologia dos ductos gera ideias confusas e aumenta a possibilidade de obstruir qualquer um dos ductos, causando iatrogenias (CACHOEIRAS et al, 2012).…”

“…Na colecistectomia, antes de remover a vesícula biliar, o médico realiza a ligadura da artéria cística (CACHOEIRAS et al, 2012). Vale ressaltar, também, que a dissecação cuidadosa do trígono cisto-hepático, no início da cirurgia, protege suas estruturas em caso de variação anatômica (WU et al, 2008).…”

Low Insertion of the Cystic Duct in the Common Hepatic Duct as a Coincidence with an Onset of a Pancreatic Cephalic Carcinoma

“…Longitudinalen i paralelen tek na bilijarnite vodovi-DC i DHK, so dol`ina pove}e od 2 cm e prisutna vo 1-25%, zavisno od razli~nite stuдii i serii [6]. Ovoj opis e sepak najblisku i do na{ite oпservacii, definicija i odreduvawe na NIDC, iako postojat trudovi i prikazi na slu~aj kadeшто dolinata na DC e i над 8 cm [7]. Skoro napravena studija na 622 pacienti so MRCP i ERCP poka`a deka postoi 100 % specifi~nost i senzitivnost vo otkrivaweto na NIDC so istovremena primena na ovie 2 metodi.…”