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RMJ. 2016; 41(3): 316-319

Anatomical variations: Dangerous culprits behind difficult cholecystectomies

Bushra Shaikh, Imammudin Balkhani Baloach, Saima Athar Shaikh.


Objective: To detect the frequency of anatomical variations of gallbladder, biliary tree and biliary vasculature during open and laparoscopic cholecystectomy.
Methodology: In our study, 994 patients underwend open/Laparoscopic cholecystectomy.
Results: 55 patients had anomalous anatomy of extra hepatic biliary tree (EHBT). These variations were intrahepatic gall bladder in 12 cases, floating gall bladder in 2 cases, phyragian cap gall bladder in 3 cases, short cystic duct in 10 cases, long cystic duct in 7 cases, accessory cholecystohepatic duct in 5 cases, MoynihanÂ’s hump in 2 cases, cystic artery anterior to cystic duct in 5 cases, cystic artery posterior to cystic duct in 4 cases, short cystic artery in 2 cases and aberrant cystic artery in 3 cases. Operative difficulties were encountered in 9 out of 50 patients in whom these anomalies were well recognized during surgery. In remaining 5 patients, anatomical variations remained unrecognized during surgery and lead to complications like bleeding and biliary leak.
Conclusion: Congenital anatomical variations in EHBT are not an uncommon happening as is usually considered; it is only that they are not well recognized during surgery.

Key words: Extrahepatic biliary tree, floating gall bladder, phyragian cap, moynihan's hump

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