Coledocolitiasis no sospechada: abordaje laparoscópico durante la colecistectomía

The Morphology and Clinical Considerations of Mucosal Folds of Cystic Duct

“…[16] Laparoscopic surgeons describe these mucosal folds as obstacles which make it difficult to cannulate the cystic duct. [1,[16][17][18][19] Some authors believe that mucosal folds are a boon in disguise as they help to restrain sludge and stones while allowing the regular flow of bile during cholecystectomy.…”

“…[2,16,18,19] They are reported to be absent in healthy ducts as well. In this study, the maximum number of mucosal folds present in a single duct is more than that found in the recent literature, [16,19] but less than that found in the pioneering study by Menzer, where he found 22 folds. In 62.5% they spanned throughout its length in this study, which is more than that of a recent study.…”

“…Saenz attributed the failure in transcystic exploration in 6% of his cases to the "not so favorable anatomy" present inside the lumen because of the folds. [19] The mucosal folds of the cystic duct and associated technicalities involved has to be taken into consideration while determining the best site to perform cysticotomy. Percutaneous transcholecystic biliary procedures also being increasingly performed nowadays.…”

“…Therefore the knowledge of the orientation of the mucosal folds is crucial and will serve as a valuable guide for surgeons while exploring the extrahepatic biliary passages especially via the transcystic approach, in the managementof cholelithiasis and diagnosis of unsuspected choledocholithiasis. [19] It will also provide valuable information indetermining the site of cystic duct division along with other factors such as duct permeability, length and breadth of the cystic duct during laparoscopic cholecystectomy.…”

Surgical Considerations of the Cystic Duct and Heister Valves

“…4 In this manner, Heister valves could also represent an obstacle that impedes a transcystic approach by reducing the lumen of the CD. 5 The term spiral valves, used by other authors, suggests that the valves possess a steady rhythmic pattern and are set in a spiral disposition. This claim has been based on the morphology observed on Heister's first diagrams, on corrosion casts of the CD, 6 and on cholangiography images.…”