Laparoscopic cholecystectomy, Calot's triangle, and variations in cystic arterial supply

Background: The extrahepatic biliary tree with the exact anatomic features of the arterial supply observed by laparoscopic means has not been describe d heretofore. Iatrogenic injuries of the extrahepatic biliary tree and neig hboring blood vessels are not rare. Accidents involving vessels or the comm on bile duct during laparoscopic cholecystectomy, with or without choledoco tomy, can be avoided by careful dissection of Calot's triangle and the hepa toduodenal ligament. Methods: We performed 244 laparoscopic cholecystectomies over a 2-year peri od between January 1, 1995 and January 1, 1997. Results: In 187 of 244 consecutive cases (76.6%), we found a typical arteri al supply anteromedial to the cystic duct, near the sentinel cystic lymph n ode. In the other cases, there was an atypical arterial supply, and 27 of t hese cases (11.1%) had no cystic artery in Calot's triangle. A typical bloo d supply and accessory arteries were observed in 18 cases (7.4%). Conclusion: Young surgeons who are not yet familiar with the handling of an anatomically abnormal cystic blood supply need to be more aware of the pre cise anatomy of the extrahepatic biliary tree.