SURGICAL CONSEQUENCES OF CYSTOHEPATIC DUCTS BASED ON A SERIES OF 29 CASES

Cysto-hepatic ducts are a rare entity constituting less than 2 % of bi liary tract operations. Twenty-nine cases have been encountered in our General Surgical Service between 1980 and 1989. The frequency is abou t 2.3 % in a series of 1 265 operative and/or postoperative cholangiog raphies analysed during the same period. Cystohepatic ducts were disco vered in 3 cases at dissection, in 10 cases on operative cholangiograp hy, in one case after biliary tract lesion, and in 15 cases on postope rative cholangiography. The cystohepatic duct was volontarily or invol ontarily respected in 23 cases, volontarily ligated in one case, invol ontarily in 2 others, cut and drained outside in one case, injured and repaired in one case, and cut in another. From our experience, we con clude that the roles of dissection of the cystic duct and the recognit ion of well known biliary bifurcation do not permit in all cases to av oid common bile duct lesions, particularly in the presence of an unfor eseeable and dangerous variant such as a cystohepatic duct draining a large hepatic territory. As a result, the first stage of cholecystecto my should not be dissection of the biliary bifurcation, ligation of th e cystic duct and its intubation but especially dissection of all elem ents of Budd's triangle before intubation of the supposed cystic duct. This avoids leaving upstream from the sectioned cystic duct, an hepat ic territory not drained by the common bile duct. A good quality syste matic operative cholangiography reveals in the other cases this anatom ical variant and constitutes an essential medico-legal document for th e ptient's and surgeon's safety.