CYSTIC DUCT ANATOMY - AN ENDOSCOPIC PERSPECTIVE

Knowledge of the junction of the cystic and common hepatic duct is ess ential for endoscopic management of biliary tract disease. The cystic and common hepatic ducts were evaluated retrospectively in cholangiogr ams obtained for a variety of indications in 524 persons. The cysticoh epatic junction was adequately visualized in 70%. Medial junctions wer e noted in 18% and a spiral configuration in 32%, both more common tha n reported. An 11% occurrence of parallel duct systems was less freque nt than expected. In 10% of patients, the cystic duct entered the hepa tic duct in the distal third of the extrahepatic biliary tree. The imp ortance of understanding this anatomy is illustrated with selected cas es of therapeutic biliary endoscopy and laparoscopic cholecystectomy c omplications. Suggestions are made for improving performance in this a rea.