scholarly journals Rare Observed Anatomical Variations of the Hepatobiliary System: Double Cystic Duct and Double Cystic Artery

2015 ◽  
Vol 5 (2) ◽  
pp. 80-82
Author(s):  
Huseyin Eken ◽  
Sercan Buyukakincak ◽  
Hamza Cinar ◽  
Koray Topgul
Keyword(s):  
Cystic Duct ◽  
Anatomical Variations ◽  
Cystic Artery ◽  
Hepatobiliary System

scholarly journals Anatomical variations of the hepatobiliary system in Sudanese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP)

2017 ◽  
Vol 5 (1) ◽  
pp. 105
Author(s):  
Wael Doush ◽  
Mohammed A/Galil ◽  
Shakir Ibrahim
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Cystic Duct ◽  
Congenital Anomalies ◽  
Vascular Anatomy ◽  
Invasive Procedure ◽  
Anatomical Variations ◽  
Ampulla Of Vater ◽  
University Hospital ◽  
Endoscopic Retrograde ◽  
Hepatobiliary System

Background: The meticulous identification of the hepatobiliary tree system normal anatomy during surgical operations is crucial in iatrogenic injury prevention. Equally important, an understanding of the congenital variations of biliary and vascular anatomy, as the literature abounds with reports of specific anatomical variations, and their surgical implications.Aim: This study aimed to study the presence of anatomical variations within the hepatobiliary system in Sudanese population undergoing endoscopic retrograde cholangiopancreatography (ERCP).Patients and methods: The records of patients undergoing ERCP in Soba University Hospital during 2004 to 2008 were analyzed. There were 277 Sudanese patients who had complained of right hypochondrial abdominal pain & history of jaundice (obstructive jaundice) that underwent ERCP were included within this study. The exclusion criteria included the following: Sudanese patients in whom ERCP failed or patients who had advanced hepatobiliary disease like cancers, strictures either cancerous or iatrogenic, fistula and iatrogenic biliary leak.Results: The analysis of 277 Sudanese patients undergoing ERCP of the hepatobiliary system showed the following results regarding the variations: The choledochal cyst type one (fusiform type) was present in 3 (1.08%) patients; very low cystic duct insertion (parallel) was present in 1 (0.36%) patient and long cystic duct was present in 3 (1.08%) patients. The ampulla of Vater size variations occurred as A) Normal in 158 (57%) patient, B) Small in 56 (20.2%) patients, C) Large in 29 (10.5%) patients, D) Periampullary diverticula in 4 (1.4%) patients and E) unclassified in 30 (10.8%) patients. Other forms of congenital anomalies were not found.Conclusion: The using of endoscopic retrograde cholangiopancreatography (ERCP) is a reliable radiological method for depicting congenital anomalies of the hepatobiliary system, but it is an invasive procedure.

scholarly journals ANATOMICAL VARIATIONS OF EXTRA HEPATIC BILIARY SYSTEM IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY IN CMH & PEMH RAWALPINDI

2021 ◽  
Vol 71 (3) ◽  
pp. 916-19
Author(s):  
Muhammad Ali Muazzam ◽  
Syed Mukarram Hussain ◽  
Muhammad Tanvir Ahmed Qureshi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gall Bladder ◽  
Hepatic Artery ◽  
Biliary Tract ◽  
Cystic Duct ◽  
Anatomical Variations ◽  
Cystic Artery ◽  
Military Hospital

Objective: To assess the frequency of anatomical variations of the extra-hepatic biliary tract in patients undergoing laparoscopic cholecystectomy in Combined Military Hospital & Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital & Pak Emirates Military Hospital, Rawalpindi, from Mar to Aug 2017. Methodology: A total of 136 patients of either gender with cholelithiasis of more than one month were included. Participants were distributed into equal number of groups for both hospitals by lottery method. All the participants had under gone laparoscopic cholecystectomy by consultant general surgeon or senior registrar under direct supervision. Structures mainly assessed for variations were gall bladder, cystic duct, common hepatic duct, supraduodenal part of common bile duct, cystic artery, and hepatic artery which were characteristically encountered during laparoscopy. Results: Overall Extra hepatic biliary variations were 136 (23%), at Combined Military Hospital 68 (16%) and Pak Emirates Military Hospital 68 (29.4%). Gall bladder anomaly was seen in 3% patients, cystic duct anomaly 4.4%, supraduodenal part of common bile duct anomaly 0.7%, cystic artery anomaly 11% and hepatic artery anomaly was seen in 3.6% patients (p>0.05). Conclusion:  Anatomic variations were found to be not uncommon in our set up. Thus, there is a need for doctors to continuously refresh knowledge of normal anatomy and the variants of biliary tract.

Variations of Cystic Duct and Its Clinical Significance

2021 ◽  
Vol 9 (4) ◽  
pp. 8120-8126
Author(s):  
K. Sangameswaran ◽  
Keyword(s):  
Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Cystic Artery ◽  
Normal Anatomy ◽  
Biliary Anatomy ◽  
Medical College ◽  
Gallbladder Surgery ◽  
The Common ◽  
Common Problems

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.

scholarly journals Right Hepatic Artery Encircle the Gallbladder: A Case Report

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Hanis M ◽  
Nasser A
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Superior Mesenteric Artery ◽  
Hepatic Artery ◽  
Cystic Duct ◽  
Mesenteric Artery ◽  
Open Cholecystectomy ◽  
Right Hepatic Artery ◽  
Hepatobiliary System ◽  
Duct Ligation ◽  
Cholecystectomy Operation

Detailed knowledge of the vascular anatomy of hepatobiliary system is important for a safe cholecystectomy. We are reporting a case of aberrant type of right hepatic artery originating from superior mesenteric artery and encircles the gallbladder that has been found during laparoscopic cholecystectomy operation. We presented a 39-year-old Malay lady came to International Islamic University Malaysia Medical Centre with features of obstructive jaundice. Ultrasound of hepatobiliary system showed cholelithiasis with choledocholithiasis causing dilatation of the common bile duct. ERCP had been performed and sphincterotomy was done. Patient was planned for laparoscopic cholecystectomy. Intraoperatively, the Calot’s triangle was identified in usual manner. However, the right hepatic artery was identified encircling the gallbladder body anteriorly before entering the liver. The procedure was converted to open cholecystectomy due to anatomical variation via Kocher’s incision. Further identification upon open cholecystectomy revealed right hepatic artery originates from superior mesenteric artery runs anterior to cystic duct and encircles the gallbladder before further branches into right and left lobe of the liver. Right hepatic artery was dissected from the gallbladder and the gallbladder removed after cystic duct ligation and separation from the liver bed. On table cholangiogram showed distal CBD stone which was pushed down to duodenum with forceps? Post-operative was uneventful and patient liver functions improved. Knowledge regarding anatomical structure and variant of hepatic artery as well as cystic artery and cystic duct is important to ensure the inadvertent ligation of right hepatic artery which would leads to hepatic ischemia and necrosis.

scholarly journals Anatomical variation of intrahepatic biliary duct in cadaveric liver

2019 ◽  
Vol 9 (4) ◽  
pp. 11-14
Author(s):  
Sushma Khatiwada ◽  
Budhi Nath Adhikari ◽  
Iju Shrestha
Keyword(s):  
Frequency Distribution ◽  
Single Case ◽  
Anatomical Variation ◽  
College Teaching ◽  
Biliary Tree ◽  
Anatomical Variations ◽  
Biliary Duct ◽  
Type D ◽  
Intrahepatic Bile Ducts ◽  
Hepatobiliary System

Background: Hepatobiliary system has many variations. Use of cadavers, intraoperative data and various imaging modalities are the commonly employed techniques for determining the anatomy of intrahepatic bile ducts. The vivid picture of hepatobiliary system is a must for hepatobiliary surgery and identification of frequency distribution of typical and atypical pattern and different types of atypical pattern are vital. This study aimed to uncover its frequency distribution and also to recognize the variations therein. Methods: An observational study was conducted in the Department of Anatomy, Kathmandu Medical College Teaching Hospital from July 2013 to June 2014 by taking 50 complete human cadaveric livers without evidence of injuries or previous operations. Livers were dissected, duct traced, colored, photographed and the findings were entered in a proforma. Results: Out of 50 dissected livers, 32 showed typical pattern (Type A, 64%) whereas 18 liver showed atypical pattern of confluence (36%). The type B pattern was seen in 6 (12%) and type C was seen in 8 of them (16%). Of these 8 cases, subtype C1 was observed in 6 livers (12%) and subtype C2 was found in 2 livers (4%). Type D was seen in 3 livers (6%). and all of them were of the subtype D1. There were no cases of subtype D2 and of type E. Type F was observed in a single case (2%). Conclusions: An accurate knowledge of the anatomical variations of the intrahepatic biliary tree is important for a successful hepatobiliay surgery.

scholarly journals Clipless laparoscopic cholecystectomy: 3 Port access.

2020 ◽  
Vol 27 (06) ◽  
pp. 1124-1127
Author(s):  
Ghulam Hassan ◽  
Saad Gulzar ◽  
Tariq Iqbal ◽  
Mohammad Imranul Haque
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Harmonic Scalpel ◽  
Cystic Artery ◽  
Safe Alternative ◽  
Medical College ◽  
Post Operative Pain ◽  
Port Access ◽  
Electric Injury ◽  
Single Instrument

Objectives: Use to ultrasound vibrations instead of electric current makes Harmonic Scalpel a safer and more efficient instrument for dissection during laparoscopic surgeries. The property of both coagulation and cutting using single Harmonic Scalpel instruments saves time of surgery reducing anesthesia load. Cystic artery and liver bed dissection has been widely used and established but a contemporary approach is the coagulation and cutting of cystic duct with Harmonic Scalpel eliminating the need for clips and reducing the epigastric port size from 10mm to 5mm thus reducing post-operative pain. Study Design: Prospective Study. Setting: This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Period: Dec, 2015 to Dec, 2017. Material & Methods: 60 patients undergoing laparoscopic cholecystectomy 3 ports were introduced one 10mm and two 5mm. the dissection and division of both cystic artery and duct was done by a single instrument, Harmonic Scalpel after tying the cystic duct with 2/0 extracorporeal knot. Results: None of the patients developed Major or Minor bile leaks or hemorrhage. Conclusion: Harmonic scalpel provides a safe alternative for dissecting and division of cystic duct and may replace the more widely used clip technique. The number of ports can be reduced to 3 and size reduced from 10mm to 5 mm. Harmonic scalpel technique eliminates the time wasted during changing of instruments per-operatively and also reduces the risk of remote electric injury.

scholarly journals Cystic vein: a guide for safer laparoscopic cholecystectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3238
Author(s):  
Debasish Samal ◽  
Rashmiranjan Sahoo ◽  
Sujata Priyadarsini Mishra ◽  
Krishnendu B. Maiti ◽  
Kalpita Patra ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Anatomic Landmark ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Constant Feature ◽  
The Relationship

Background: Major complications of laparoscopic cholecystectomy are bleeding and bile duct injury, and it is necessary to clearly identify structures endoscopically to keep bleeding and injury from occurring. The aim of this study was to depict the anatomic landmark in the Calots triangle, a vein (cystic vein), a constant feature which can help Laparoscopic surgeons to conduct a safe LC along with other precautions to be adopted. Methods: A total of 100 patients (58 male, 42 female) who underwent cholecystectomy were examined preoperatively by clinically. The origin and number of cystic veins and their relationship with the Calot triangle was evaluated. Results: The cystic veins were delineated intraoperatively in 80 of the 93 patients. The relationship between the cystic vein and the Calot triangle was identified in 80 (86.02%) of the 93 patients. One cystic vein was found in 53 (66.25%) patients, while multiple cystic veins were found in 27 (33.75%) patients. All these veins are above the cystic common bile duct junction. Conclusion: The configuration of the cystic veins and their relationship in the Calot triangle with cystic artery and cystic duct can be identified intraoperatively and used as a guideline for safe laparoscopic cholecystectomy. 

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