Morphological Characteristics of The Arterial Supply of The Extra- Hepatic Biliary System (original) (raw)
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Journal of Translational Medicine and Research, 2016
Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, laparoscopic hepatobiliary surgery and other open procedures such as open cholecystectomy, biliary stricture surgery, are performed regularly throughout the world and extrahepatic biliary tract is one of the most common sites of the surgical procedures. The incidence of biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. Apart from various other causes of biliary injuries aberrant anatomical course of extrahepatic biliary system is a well established fact of iatrogenic ductal injury. Thus, an adequate recognition and awareness of anatomical abnormalities of extra hepatic biliary tree with its vessel, can decrease the morbidity and mortality related to the surgery. Methods: Study was done in Department of Surgery, Gandhi Medical College and Hamidia Hospital Bhopal, India on 100 cases, during period of Aug 2014 to Nov 2015, and dissection was carried out in department of Forensic Medicine and Toxicology after taking permission from ethical committee. Results: In 100 cases of study 72 were male and 28 were female in which 16% male and 10.7% female showed variations in their anatomy. The most common variation which we observed in our study was short cystic duct in 8 cases, and second most common variations was cystic artery origin, from left hepatic artery in 3 cases and from proper hepatic artery in 1 case, other variations were floating gall bladder in 1 case, intrahepatic union of left hepatic duct and right hepatic duct in 3 cases, low insertion of cystic duct in 3 cases, high insertion of cystic duct to common hepatic duct in 1 case,and in one case cystic artery passing anterior to common hepatic duct. Conclusion: There was a significant variations seen in extrahepatic biliary apparatus and its related arterial supply in our study, and these variations observed could definintely be useful to hepatobiliary, laparoscopic surgeons and radiologist. And will further contribute to literature available on variations of extrahepatic biliary system.
British Journal of Surgery, 2022
The aim of this project was to examine world literature to establish the various types and frequencies of anatomical variants within the extrahepatic biliary tree, thereby contributing to the body of information available to anatomists, surgeons, and radiologists. Knowledge of the notoriously variable anatomy of the extrahepatic biliary tree is of greater importance than ever, given the increased occurrence and complexity of hepatobiliary and laparoscopic surgeries. Method: A database search of MEDLINE, EMBASE and PubMed was conducted in June 2021 and returned 3440 articles, of which 29 were deemed eligible for inclusion. Results: A rare malposition, the left-sided gallbladder, was observed in 0.04-0.60% across five studies. A normal cystic artery origin, that is, from the right hepatic artery was observed in 73.3-92% with variations being seen from the left hepatic artery (1-1.9%), gastroduodenal artery (1-7.5%) and the aberrant right hepatic artery (3-12.1%). It was also noted that in 3.6-32% of subjects the course of the cystic artery lay extraneous to Calot's triangle. Michels' and Hiatt's classification systems were used to define the anatomical variations of the hepatic arteries: studies using Michels' Type III reported a prevalence from 6.4-15%, Michels' Type VI from 0.6-7% and Hiatt's Type III recorded an incidence ranging from 9.7-14.8%. Conclusion: The most obvious finding to emerge from this project was the widely variable anatomy of the extrahepatic biliary tract and the contrasting reported data. Surgeons should therefore anticipate such complexities and adapt techniques to avoid biliary and arterial injuries and associated intra-and postoperative complications.
Clinicoanatomical Study of Blood Supply of Extrahepatic Biliary Ductal System
The major blood supply of extrahepatic biliary ductal system is by cystic artery, which supplies to cystic duct, common hepatic duct and the upper part of the common bile duct. The lower part of bile duct is supplied by gastroduodenal artery. The present study is aimed at determining the anatomical variations of blood supply of extrahepatic biliary ductal system and its clinicalimplications. The present study of the blood supply of extrahepatic biliary ductal system has been conducted on 30 cadavers. After exposing the abdominal cavity and removing peritoneal fat, extrahepatic biliary system and its blood supply was carefully dissectedand relevant photographs were taken. Special attention was given to the relationship of the cystic artery to the Calot’s triangle. Along with the arteries, the variations in the venous drainagewere also noted. Major importance of knowledge of blood supply of extrahepatic biliary ductal system may well lie in the understanding of the etiology of postoperative bile duct strictures and in their prevention. A clear understanding of the major arterial supply to the extrahepatic bile ducts should be of assistance in biliary reconstruction and treating hemobilia.
Variations of the Extrahepatic Biliary Tract: Cadaveric Study
IOSR Journal of Dental and Medical Sciences, 2013
The extra-hepatic biliary tract includes: right and left hepatic ducts, common hepatic duct, gallbladder, cystic duct and common bile duct. The variation in this system is seen in less than 50% of the cases. This study was carried out to describe the anatomical variations of the extra-hepatic biliary tract as these variations are important during surgical procedures such as laparoscopic cholecystectomy thereby decreasing the post-operative complications.
2003
Bile duct injuries have been recorded with open cholecystectomy (OC) long before the introduction of laparoscopic cholecystectomy (LC) (Lillemoe et al, 2000). The introduction of OC by Langenbuch of Berlin in 1882 brought about the world wide use of OC for the management of symptomatic gall stones. After that, injuries to the biliary tree became a recognized complication of operation (Roslyn et al, 1993). Over the last decade, the incidence of bile duct injuries after OC has been estimated at 0.1% to 0.3% (Edmond and Marvin, 2001).
International Surgery Journal, 2019
Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been recognized and are of clinical importance because when present may surprise the surgeon during surgery and lead to iatrogenic injuries. Surgeries on extra-hepatic biliary apparatus and pancreas are regularly performed throughout the world. Thus insight into the normal anatomy and congenital variations will reduce complication and definitely improve outcome.Methods: Study was conducted in department of surgery GMC Bhopal and dissection was carried out in Department of Forensic Medicine on 100 cadavers with approval from ethical committee.Results: In 100 cases 70 were male and 30 female. The most common variation in extra hepatic biliary apparatus was short cystic duct was found in 6% cases then formation of common hepatic duct by union of right hepatic duct and left hepatic duct was intrahepatic in 3% cases. There was low insertion of cystic duct with common hepatic duct in 1% case. Cystic ...
African Health Sciences
Introduction: The knowledge of anatomy is essential for surgical safety and impacts positively on patients’ outcomes. Surgeons operating on the liver and bile ducts should keep in mind the normal anatomy and its variations as the latter are common. Case Presentation: We conducted a structured surgical dissection course of the supra-colic compartment of the abdominal cavity on 2nd and 3rd October 2020. While dissecting a 46years-old male cadaver, we encountered unusual anatomical variations of the hepatic arterial branching, the biliary tree, and arterial supply to the common bile duct. The common hepatic artery was dividing into two branches: a common short trunk for the left hepatic artery and the right gastric artery (hepato-gastric trunk) and a common trunk for the right hepatic artery and gastroduodenal artery (hepato-gastroduodenal trunk). The right hepaticduct was duplicated with a main right hepatic duct and an additional smaller duct. The bile duct was supplied by an artery ...
Biliary tract anatomy and its relationship with venous drainage
Journal of clinical and experimental hepatology, 2014
Portal cavernoma develops as a bunch of hepatopetal collaterals in response to portomesenteric venous obstruction and induces morphological changes in the biliary ducts, referred to as portal cavernoma cholangiopathy. This article briefly reviews the available literature on the vascular supply of the biliary tract in the light of biliary changes induced by portal cavernoma. Literature pertaining to venous drainage of the biliary tract is scanty whereas more attention was focused on the arterial supply probably because of its significant surgical implications in liver transplantation and development of ischemic changes and strictures in the bile duct due to vasculobiliary injuries. Since the general pattern of arterial supply and venous drainage of the bile ducts is quite similar, the arterial supply of the biliary tract is also reviewed. Fine branches from the posterior superior pancreaticoduodenal, retroportal, gastroduodenal, hepatic and cystic arteries form two plexuses to supply...
Anatomical variants of the hepatic artery: An Australian perspective
International Journal of Anatomical Variations, 2020
L aparoscopic cholecystectomy is a very common general surgical procedure. It was performed on: 216 per 100,000 members of the Australian population; 202 per 100,000 in Canada; and, 125 per 100,000 in the United Kingdom [1]. Anatomical variants of the hepato-biliary vasculature are commonly encountered during such upper abdominal procedures and, without prior identification and knowledge, inability to recognize such variations may predict significant complications, morbidity and even occasional mortality. The particular risks are haemorrhage and bile duct injury, requiring a conversion from laparoscopic to open surgery. In one study, a conversion rate to open of 9% was quoted, the culprit being poor delineation of anatomy [2]. Publicly, this is associated with longer hospital stays and additional health costs. The cystic artery is thus an important structure in cholecystectomy and its clear delineation in "The Critical View of Safety" is paramount prior to its dissection and related structures [3]. On review of the global literature, the incidence of atypical variations of the Cystic Artery vary widely across populations however yet to be described in the Australian population. Given the high incidence of cholecystitis and the broad ethnic demographic of Australia, local studies are needed to describe the variations amongst this significant population which is the aim of this article. Normal anatomy The cystic artery is the primary blood supply to the gall bladder, although it also receives an adequate supply of blood from the vessels that lay within in the gall bladder bed [4]. Origin and course: The cystic artery classically arises as a singular artery originating within Calot's triangle from the right hepatic artery. In the anatomical specimen it passes behind the cystic duct to reach the neck of the
Accessory hepatic artery: incidence and distribution
Jornal Vascular Brasileiro, 2010
Background: Anatomic variations of the hepatic arteries are common. Preoperative identification of these variations is important to prevent inadvertent injury and potentially lethal complications during open and endovascular procedures. Objective: To evaluate the incidence, extra-hepatic course, and presence of side branches of accessory hepatic arteries, defined as an additional arterial supply to the liver in the presence of normal hepatic artery. Methods: Eighty-four human male cadavers were dissected using a transperitoneal midline laparotomy. The supra-celiac aorta, celiac axis, and hepatic arteries were dissected, and their trajectories were identified to describe arterial branching patterns. Results: Normal hepatic arterial anatomy was identified in 95% of the cadavers and six (5%) had accessory hepatic arteries. In five cadavers the accessory hepatic artery followed its course through the fissure for ligamentum venosum, and in one it coursed adjacent to the hepatic artery th...