Comparative Analysis of Anatomy Following Intraoperative Cholangiograms in Elective Laparoscopic Cholecystectomies

Abstract

Background: Laparoscopic cholecystectomies are performed more than 650,000 times per year in the United States. The importance of understanding the anatomy of the biliary system variants is essential to all surgical procedures, which can minimize surgical errors and common bile duct (CBD) injuries. Anatomic variants are seen in 18-39% of cholecystectomies, wherein 3-6% lead to increased risk of biliary tract injuries. We aim to show that anatomic variants do exist at a substantial rate and that performing intraoperative cholangiograms can prevent associated complications.

Methods: Data on 22 elective laparoscopic cholecystectomies due to acute cholecystitis were collected. All received intraoperative cholangiograms utilizing standard angiographic catheterization. Intraoperative cholangiograms were evaluated for anatomic variants. Complications were noted to compare and document relative risk of each anatomic variant.

Results: Thirty-six percent of patients presented with anatomic variations in their biliary system, right posterior segmental duct (RPSD) draining into the CBD, trifurcation of right anterior segmental duct (RASD), RPSD, and left hepatic duct (LHD) draining into the CBD, and accessory hepatic duct draining into common hepatic duct; all occurred at the same frequency of 10.5% each respectively, with the remaining 5.26% coming from patients with the RPSD draining into the LHD. Patients with anatomic variations had zero intraoperative complication.

Conclusion: This study highlights the importance of intraoperative cholangiograms in understanding the anatomy of the biliary system, and minimizing bile duct injuries to prevent the morbid risk associated with the procedure for those patients with variations in ductal anatomy.




J Curr Surg. 2015;5(4):183-187
doi: http://dx.doi.org/10.14740/jcs280w