Clinicoanatomical Study of Blood Supply of Extrahepatic Biliary Ductal System (original) (raw)
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Morphological Characteristics of The Arterial Supply of The Extra- Hepatic Biliary System
IOSR Journal of Dental and Medical Sciences, 2016
Introduction: A comprehensive knowledge of the regional anatomy and abnormalities of the arterial supply to the extra-hepatic biliary system is a requisite for safe biliary tract surgery. Objective: To describe morphological characteristics of arterial supply to extra-hepatic biliary system using human cadavers. Method: Descriptive-prospective cross sectional study was performed in 60 cadavers, to observe variations in arterial supply to extra-hepatic biliary system. Results: The mean length of right and left hepatic arteries was 2.8cm and 2.3cm respectively. The mean length of proper hepatic artery was 3.1 cm. The mean length of cystic artery was 1.4cm before its division into anterior and posterior branches ranged from 0.9cm to 2.1 cm. 74.9% of the cystic arteries originated as a single artery from the right branch of the hepatic artery. In 43% of the specimens, right hepatic artery was lying in the triangle of Calot's. Conclusion: Variations in arterial supply inrelation to the extra-hepatic biliary system vasculature is common.
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.
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).
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.
Anatomical variation of intrahepatic biliary duct in cadaveric liver
Journal of Chitwan Medical College
Background: Hepatobiliary system has many variations. Use of cadavers, intraoperative data and various imaging modalities are the commonly employed techniques for determining the anatomy of intrahepatic bile ducts. The vivid picture of hepatobiliary system is a must for hepatobiliary surgery and identification of frequency distribution of typical and atypical pattern and different types of atypical pattern are vital. This study aimed to uncover its frequency distribution and also to recognize the variations therein. Methods: An observational study was conducted in the Department of Anatomy, Kathmandu Medical College Teaching Hospital from July 2013 to June 2014 by taking 50 complete human cadaveric livers without evidence of injuries or previous operations. Livers were dissected, duct traced, colored, photographed and the findings were entered in a proforma. Results: Out of 50 dissected livers, 32 showed typical pattern (Type A, 64%) whereas 18 liver showed atypical pattern of confl...
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...
Biliary ductal variations and its clinical implications: a cadaveric study
International Journal of Research in Medical Sciences
Background: Biliary ductal region being frequently abnormal has been the subject of research since long time for anatomists, surgeons and radiologists as well.Methods: The present study was carried out in the department of Anatomy at PGIMS, Rohtak on 50 specimens of liver taken unblock with associated structures.Results: Accessory hepatic and accessory cystic ducts were observed in 4% cases each. 2% cases exhibited abnormal low fusion of cystic duct with common hepatic duct.Conclusions: These anomalies may add to postoperative complications if ignored. Present study is a step in the direction of creating awareness about these variations among the clinicians.
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 ...
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.
Anatomic variations in intrahepatic bile ducts in a north Indian population
Journal of Gastroenterology and Hepatology, 2008
In the present study, we described the anatomical variations in the branching patterns of intrahepatic bile ducts (IHD) and determined the frequency of each variation in north Indian patients. There are no data from India. Methods: The study group consisted of 253 consecutive patients (131 women) undergoing endoscopic retrograde cholangiograms for different indications. Anatomical variations in IHD were classified according to the branching pattern of the right anterior segmental duct (RASD) and the right posterior segmental duct (RPSD), presence or absence of first-order branch of left hepatic duct (LHD) and of an accessory hepatic duct. Results: Anatomy of the IHD was typical in 52.9% of cases (n = 134), showing triple confluence in 11.46% (n = 29), anomalous drainage of the RPSD into the LHD in 18.2% (n = 46), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 7.1% (n = 18), drainage of the right hepatic duct (RHD) into the cystic duct 0.4% (n = 1), presence of an accessory duct leading to the CHD or RHD in 4.7% (n = 12), individual drainage of the LHD into the RHD or CHD in 2.4% (n = 6), and unclassified or complex variations in 2.7% (n = 7). None had anomalous drainage of RPSD into the cystic duct Conclusion: The branching pattern of IHD was atypical in 47% patients. The two most common variations were drainage of the RPSD into the LHD (18.2%) and triple confluence of the RASD, RPSD, and LHD (11.5%).