Morphological Variations of the Cystic Duct and its Clinical Significance

Abstract

Background: Anatomical variations of the cystic duct (CD) are common with an incidence of 18%–23% and are commonly encountered during cholecystectomy. The prevalence of such variations in our region is recorded so as to create awareness to avoid significant ductal injury in biliary surgery. Methodology: This observational cross-sectional study was undertaken on one hundred specimens of liver with extrahepatic biliary apparatus available in the department of anatomy. The morphology of CD was studied with respect to its length, course, mode, and level of union. Descriptive statistical analysis was done. Results: The range of length of the CD varied between 0.6 and 5.5 cm. The mean length of the CD was 2.06 ± 1.142 cm. 15% were short CDs and 3% had long CDs. The CD opened into the right hepatic duct in 2% and there was a triple confluence in 1%. There was a high union of CD with common hepatic duct (CHD) in 7.2% and a low union in 3.1%. The CD joined the CHD at an acute angle in 82.47% laterally and medially in 1.03%, paralleled in 11.3% of which 9.3% had a short parallel course, and 2% had a long parallel course and spiralled either anteriorly or posteriorly in 5.2%. Conclusion: These variations of CD have surgical significance in order to avoid damage to the ducts during surgical procedures, especially with increasing laparoscopic cholecystectomies. Hence, an awareness to look for these variations in preoperative radiological imaging is essential for the surgeons to avoid catastrophes.