Preoperative evaluation of the extrahepatic bile d

Authors: K Uchiyama M Tani M Kawai M Ueno T Hama H Yamaue

Publish Date: 2006/05/13

Volume: 20, Issue: 7, Pages: 1119-1123

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Abstract

The incidence of aberrant bile duct injury associated with laparoscopic cholecystectomy LC has not yet been adequately examined This study aimed to clarify the types of normal cystic ducts and the incidence of aberrant extrahepatic bile ducts and to search for a method of avoiding injuries during LCAberrant hepatic ducts were retrospectively categorized into five types according to the pattern of the cystic ducts and the accessory hepatic ducts by preoperative endoscopic retrograde cholangiography or multidetector threedimensional computed tomography using drip infusion cholangiography The aberrant bile ducts were classified as type A merging at the right side of the common bile duct type B merging at the anterior side or type C merging at the posterior left sideThe intrahepatic bile ducts and cystic duct were clearly shown for 1044 of the 1278 patients who underwent LC Secondary branches of aberrant cystic ducts were observed in 37 cases 35 and accessory hepatic ducts were observed in 30 cases 29 A comparison of the difficulties encountered with LC for each type based on the merging patterns of cystic ducts showed that type C needed a much longer operation time for LC than the other typesA preoperative evaluation of the bile duct tract and the accessory hepatic duct before LC is important Patients with a cystic duct merging normally into the posterior left side of the common hepatic duct type C experienced difficulty when undergoing LC The authors have safely performed LC with the use of an endoscopic nasobiliary drainage tube in type D cases cystic duct merging with the right hepatic duct in type IV cases cystic duct merging with an accessory hepatic duct

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