Diagnosis and Managements of the Anatomic Variation of the Extrahepatic Biliary Tree during Laparoscopic Cholecystectomy / 中国微创外科杂志

ABSTRACT

Objective To explore the diagnosis and treatment of anatomic variation of the extrahepatic biliary tree in laparoscopic cholecystectomy(LC).Methods From October 1999 to January 2008,totally 1216 cases of LC were performed in our hospital,anatomic variation of the extrahepatic biliary tree was found in 15(1.2%) of them.Among the 15 patients,3 had wide and short cystic duct with the opening at the junction of the right and left hepatic ducts;1 patient showed dislocation of a relatively thin choledoch owing to calculus incarceration;1 case was found having a cystic duct parallel to the common hepatic duct with a low-level opening;1 patient had twisted cystic duct at the right side of the common bile duct with an opening at the right hepatic duct;2 patients were suffered from massive adhesion in the cystic ampulla that covering the common bile and common hepatic ducts;3 cases showed aberrant bile ducts lying on the gallbladder bed;3 patients were found having the right posterior hepatic duct opened to the common hepatic duct;1 case was diagnosed with Mirizzi syndrome,in whom the anatomical structure was unclear.For all of the patients,the abnormal structures were separated carefully,ligated with sutures or titanium clips if necessary.Results LC was completed in 13 of the 15 cases,the other 2 patients were converted to open surgery because of the injury to the right hepatic duct or Mirizzi syndrome.None of the series had intra-abdominal bleeding or infection,bowel injury,or death.The patients were followed up for 3 months to 4 years(over 1 year in 11 cases).None of them developed biliary stenosis or residual calculus.Conclusion Identification of the Calot triangle is crucial to prevent surgical injuries to the extrahepatic biliary tree.