616 A Rare Biliary Duct Anatomical Variant Encountered During a Routine Cholecystectomy

Cholecystectomy, a common surgical procedure, faces complexities due to variations in biliary anatomy. Although bile duct injuries are uncommon, their potential for morbidity necessitates careful consideration. In this report, we present a case featuring a rare anatomical variant of the biliary duct, previously unreported in the literature. A 53-year-old female, suffering from persistent biliary colic symptoms, underwent elective laparoscopic cholecystectomy. During the closure phase following gallbladder resection, the surgeon identified a small hole in one of the hepatic ducts, prompting intervention with a T-Tube. Subsequently, the patient was referred to a tertiary centre for in-depth evaluation and management. Intraoperative cholangiography (IOC) conducted revealed a unique anatomical configuration, illustrating a right posterior sectoral duct draining into the left hepatic duct (Huang type III), connected to an accessory cystic duct, the Duct of Luschka. Despite unsuccessful attempts at intraductal stenting, the decision was made for biliary reconstruction via hepatico-jejunostomy, resulting in the patient's full recovery with no postoperative complications. Currently, there are no clear guidelines regarding routine mapping of anatomical variations using imaging techniques such as IOC. The evidence in this area remains controversial due to the balance between the potential prevention of biliary duct injuries and the cost-effectiveness of such measures. More research is needed in this area, but at present, such considerations are made on a case-by-case basis. This case underscores the challenges posed by unexpected anatomical variants during routine cholecystectomy and highlights the importance of adaptability in surgical management.