Surgical oriented anatomical study of variations in extra-hepatic biliary ductal system & its related vessels with its clinical significance
Keywords:
Hepatic duct, Common bile duct, cystic duct, Gall bladder
Abstract
Background: Basic prerequisites for being a good surgeon are knowledge, and understanding of anatomy and embryology. Proper understanding of general knowledge of anatomy and embryology are the basic pre-requisites for being a good surgeon. The bile duct injury is a rare but one of the most common complications. Variations are important to the surgeon because failure to recognize them may lead to inadvertent ductal ligation, biliary leaks, Haemobilia, Hemorrhage and Strictures after laparoscopic or open cholecystectomy.Methods: 200 cadavers subjected for post-mortem examination in Forensic Deptt., M.Y. Hospital, Indore. Result: Variations in gall bladder is seen in respect to shape is seen in case no 115.Hartman's pouch is seen in 26 cases out of 200. The right and left hepatic ducts united outside the porta hepatis to form the common hepatic duct in 141/200 (70.5%) specimens. The average length of the ducts observed in the study are Cystic duct 2-4 cms, common hepatic duct 2-3 cms and common bile duct 5-8 cms. Three types of union of cystic duct with common hepatic duct. 1).Angular type: - observed in 150 specimens (75%), 2)Parallel type: 40 specimens (20%) were observed to be parallel type 3) Spiral type: 5% (10 cases) of the specimens were found to be of spiral type. Level of termination of cystic duct: normal level was observed in 172 (86%) specimens. High level union was noted in 8 specimens (4%).Conclusion: Many variations have established in this region and understanding of these variations is undoubtedly important for operating surgeons.References
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2) Eisendrath DN (1918) Anomalies of the bile ducts and blood vessels: as the cause of accidents in biliary surgery. JAMA 71:864–867
3) Thompson IM. On the arteries and ducts in the hepatic pedicle; A study in statistical human anatomy. Univ. California Publ Anat. 1933;(1):55
4) Hossein Mahour M.D., The common bile duct in man. Ann. Surg. 1961; 165: 415 – 419.
5) Henry Hollinshead Ph.D., Anatomy for Surgeon. 1952; Vol. 2, Editors: Paul B.
6) Edward V Johnston, Barry J Anson. Variations in the formation and vascular relationship of the bile ducts. Surg Gynecol Obstet 1952;94(6):669-686..
7) Gray's Anatomy. The anatomical basis of clinical practice.2008, 40th edition, Editors: Susan standring.
8) Schanchner A. Anomalies of the gall-bladder and bile-passages. Ann Surg 1916;64:419-33.
9) Flint .E.R. Abnormalities in Anatomy of Bile tract. British Journal of surgery 1922- 23; 10:509-519.
10) Henry Gray. Gray's Anatomy descriptive and applied; 1938: 28th edition, Editors: T.B. Johnston.
11) Daseler EH, Anson BJ, Hambley WC, Reiman AF. Cystic artery and constituents of the hepatic pedicle. Surg Gyn & Obst. 1947;85:47.
Published
2018-04-07
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Original Article
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