Anatomical Variations in Cystic Artery Observed during Laparoscopic Cholecystectomy: A Cross-sectional Study from West Bengal, India

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Introduction: Laparoscopic cholecystectomy, while considered the gold standard for managing symptomatic gallstone disease, can lead to complications such as iatrogenic injuries to the cystic artery and bile duct. Therefore, surgeons must possess a comprehensive understanding of the anatomical variations of the cystic artery to identify a safe dissection area. Aim: To determine the association between the anatomical variations of the cystic artery, the clinical profiles of patients, and the final surgical approach adopted during cholecystectomy. Materials and Methods: The present cross-sectional study was conducted in the Department of Surgery, Deben Mahata Government Medical College and Hospital, Purulia, West Bengal, India, from April 2023 to March 2024. Study was conducted among 196 patients undergoing laparoscopic cholecystectomy. Data were collected using a predesigned structured schedule and hospital records to assess the clinical profiles of patients, anatomical variations in the cystic artery and the surgical approaches adopted. Bivariate analyses were performed using the Fisher’s-exact test to determine the associations between anatomical and clinical variables, and conversion to open cholecystectomy, using Jamovi (Solid version 2.3.28). Results: The mean age of the participants was 41.75±12.68 years, with 45 males and 151 females. The most common position of the cystic artery was superomedial, 176 (89.8%), while the anterior position was the least common, 5 (2.5%), in relation to the cystic duct. The right hepatic artery was the origin of the cystic artery in 189 (96.4%) patients. The operative procedure was converted to open cholecystectomy in 11 patients. The proportion of patients undergoing open cholecystectomy was higher in males, (6/45, 13.3%) compared to females, (5/151, 3.3%) (p-value=0.0196), more prevalent among acute-on-chronic patients, (6/27, 22.2%) compared to those without, (5/169, 3.0%) (p-value=0.0011), and among patients with mucocele, empyema, or both (7/29, 24.1%) vs those without (4/167, 2.4%) (p-value=0.0001). Conclusion: The anterior position of the cystic artery in relation to the cystic duct was the least common finding in Calot’s triangle. To reduce the risk of iatrogenic injury to the cystic artery, blind dissection in Calot’s triangle should begin from the anterior aspect of the cystic duct.