Volvulus of the gallbladder: Beware of aberrant biliary anatomy

Background: Cystic duct drains the bile from the gallbladder into the common bile duct. Gallstone disease is one of the most common problems affecting the digestive tract and may lead to many complications. To avoid the complications in these patients the gallbladder is removed surgically (Cholecystectomy). Ligation of cystic duct and cystic artery is a prerequisite procedure when cholecystectomy is done. Understanding about the normal anatomy & the possible variations in biliary ductal system is important for the surgeons for doing cholecystectomy surgery successfully. Errors during gallbladder surgery commonly result from failure to appreciate the common variations in the anatomy of the biliary system. Aim of the study: To find out the incidence of variations in the length, course, and termination of cystic duct in cadavers. Materials and Methods: Present study was done in 50 adult cadavers in the Department of Anatomy, Government Tiruvannamalai medical college, Tamilnadu. Meticulous dissection was done in the hepatobiliary system of these cadavers. Observations: During the study variations in the length of cystic duct, course and different modes of insertion of cystic duct were observed. Conclusion: Knowledge of variations in the length of cystic duct and knowing about different modes of course & insertion of cystic duct is necessary for surgeons while conducting cholecystectomy. The risk of iatrogenic injury is especially high in cases where the biliary anatomy is misidentified prior to surgery. KEY WORDS: Cystic duct, Gallbladder, Cholecystectomy.

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Biliary Anatomy

The SAGES Manual of Biliary Surgery ◽

10.1007/978-3-030-13276-7_2 ◽

2019 ◽

pp. 5-23

Author(s):

Daniel J. Deziel ◽

Benjamin R. Veenstra

Keyword(s):

Biliary Anatomy

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Biliary anatomy as applied to pediatric living donor and split-liver transplantation

Liver Transplantation ◽

10.1053/jlts.2000.19365 ◽

2000 ◽

Vol 6 (6) ◽

pp. 801-804 ◽

Cited By ~ 24

Author(s):

John F. Renz ◽

Paulo R. Reichert ◽

Jean C. Emond

Keyword(s):

Liver Transplantation ◽

Living Donor ◽

Biliary Anatomy ◽

Split Liver Transplantation ◽

Split Liver

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INDOCYANINE GREEN ENHANCED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE PATIENTS: DO WE NEED A REVISION OF THE SAFETY PARADIGMS?

Romanian Medical Journal ◽

10.37897/rmj.2017.2.10 ◽

2017 ◽

Vol 64 (2) ◽

pp. 151-154

Author(s):

Catalin Alius ◽

◽

Eugen-Sebastian Gradinaru ◽

Adriana Elena Nica ◽

◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Augmented Reality ◽

Surgical Technique ◽

Indocyanine Green ◽

Near Infrared ◽

Fluorescent Dyes ◽

Operating Time ◽

Biliary Anatomy ◽

Early Laparoscopic Cholecystectomy ◽

Small Cohort

Introduction. Rapid developments in medical technology have allowed the incorporation of Indocyanine green (ICG) fluorescent cholangyography in the surgical technique armamentarium. The visualization of the biliary anatomy with augmented reality devices during surgery reduces complications and offer the perspective of challenging the safety paradigms which prohibited surgery in certain acute biliary conditions. Materials and methods. 43 consecutive patients were enrolled in a prospective interventional study and randomly divided into a cohort of 19 patients who had ICG injected prior to laparoscopic cholecystectomy and a cohort of 23 patients who received no fluorescent dye prior to surgery. In the ICG lot a Near Infrared Fluorescent System was used for the acquisition of fluorescent data in order to produce real time augmented reality imaging (ICG fluorescent cholangiography). The surgical technique and the indications for surgery were the same for the same in both cohorts of patients. Results and discussion. The cohort of patients receiving ICG had no complications and the mean operating time was 10 minutes less. The biliary anatomy was identified immediately in the ICG cohort with a specificity of 89.4% for the common bule duct and 73.6% for the cystic duct. In the non ICG cohort 21% of the CBDs and 43.4% of the cystic ducts were identified with difficulty during the procedure. Conclusion. We demonstrated in a small cohort of patients that early laparoscopic cholecystectomy is safe and can be performed quicker with the aid of fluorescent dyes. In order to challenge the safety paradigms around the early laparoscopic cholecystectomy a larger study is necessary.

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Rendezvous for afferent limb syndrome

Clinical Medical Reviews and Reports ◽

10.31579/2690-8794/049 ◽

2020 ◽

Vol 2 (9) ◽

pp. 01-04

Author(s):

Ivan Mendez

Keyword(s):

Pancreatic Cancer ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Stent Placement ◽

Whipple Procedure ◽

Metallic Stent ◽

Biliary Anatomy ◽

Endoscopic Retrograde ◽

Afferent Limb ◽

Rendezvous Technique ◽

Metallic Stent Placement

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgical alterations in the normal biliary anatomy is technically challenging. We describe the case of a 73-year-old patient with an afferent limb syndrome secondary to a Whipple procedure for pancreatic cancer, in which a percutaneous rendezvous technique assisted in the endoscopic metallic stent placement with favorable outcome.

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