EXTRAHEPATIC BILIARYANATOMY VARIATION ENCOUNTERED DURING LAPAROSCOPIC CHOLECYSTECTOMY


Sah N P, Sah S P, Khaniya S, Awale L, Agarwal CS, Adhikary S

ABSTRACT

Background : Cholelithiasis is one of the common surgical problems worldwide and cholecystectomy offers complete cure for the disease. Though, cholecystectomy is one of the most common major surgical procedures, it comes with the surprise to the surgeon due to high association with congenital anomalies of extra hepatic biliary tree.

Objectives : The primary objective is to assess the variability of the anatomy of the extra-hepatic biliary systems in terms of Extra-hepaticBile ductal anomaly including Gall bladder; Cystic duct and Vascular anomaly seen at Calot’s triangle. The secondary objectives are to study demographic profile of gallstone patients and outcome of laparoscopic cholecystectomy.

Methods : The study was conducted at B. P. Koirala Institute of Health Sciences, Dharan for One year ( 2014- 2015). The inclusion criteria were all the patients undergoing laparoscopic cholecystectomy in the Department of General Surgery. The exclusion criteria were CBD Stone, malignancy of Extra hepatic biliary tree,Cholecystectomy as a part of other surgery and Open cholecystectomy.

Results : In our study among 335 patients, anatomical variation was noted in 33 patients (9.85%). There were 5 gallbladder anomaly, 11 cystic duct anomaly, 4 Right hepatic artery anomaly and 13 cystic artery anomaly. Biliary leakage present in 2 case.There was no mortality.

Conclusion : Though Congenital anomalies of extra- hepatic biliary tree are not common but can be of clinical importance and surprise if present. So every surgeon should assess for these anomalies during laparoscopic cholecystectomy in order to prevent inadvertent ductal clipping, ductal injuries, strictures and bleeding problems. 

Key words: Extrahepatic biliary, cholecystectomy