Extrahepatic Biliary Anatomy at Laparoscopic Cholecystectomy: Is Aberrant Anatomy Important?

BACKGROUND: The prevention of major duct injury at cholecystectomy relies on the accurate dissection of the cystic duct and artery, and avoidance of major adjacent biliary and vascular structures. Innumerable variations in the anatomy of the extrahepatic biliary tree and associated vasculature have been reported from radiographical and anatomical studies, and are cited as a potential cause of bile duct injury at cholecystectomy. METHODS: A photographic study of the dissected anatomy of 186 consecutive cholecystectomies was undertaken and each photo analysed to assess the position of the cystic duct and artery, the common bile duct and any anomalous structures. RESULTS: The anatomy in the region of the gallbladder neck was relatively constant. Anatomical variations were uncommon and anomalous ducts were not seen. Vascular variations were the only significant abnormalities found in the present series. CONCLUSION: Anatomy in the region of the gallbladder neck varies mostly in vascular patterns. Aberrant ducts or duct abnormalities are rarely seen during cholecystectomy hightlighting the principle that careful dissection and identification is the key to safe cholecystectomy.