The prevention of bile duct injury during laparoscopic cholecystectomy from the point of view of anatomic variation

The aim of this study was to evaluate ways to prevent bile duct injury duri ng laparoscopic cholecystectomy in patients with anomalous biliary tract an atomy. The biliary tract was studied using cholangiograms of 511 patients w ho had gallbladder disease and was dissected in 92 cadaveric specimens. The authors classified confluent forms of the cystic duct and the bile duct in to five different types, including four anomalous types. Sixteen instances (3.13%) of anatomic variation of the biliary tract were found among the pat ients, and four cases (4.35%) were found in the cadavers. Among the 511 pat ients, there were 495 cases of type C anatomy, three cases of type A, seven cases of type R, six cases of type P, and zero cases of type L; among the 92 cadaveric specimens, there were 88 cases of type C anatomy, one case of type R, two cases of type P, and one case of type L. For anatomic types A, P, and R, there is a high probability of risk of cutting the wrong duct. Th erefore, it is important to clarify the anatomy of the biliary tract by pre operative examination and to carefully dissect the cystic duct close to the neck of the gallbladder during laparoscopic cholecystectomy. Anatomic vari ation of the biliary tract is common and can create a rare pitfall during l aparoscopic cholecystectomy.