A cautionary tale of anatomical variations of the extrahepatic biliary system and their implications for surgical procedures: a systematic literature review.

IF 1.4 4区 医学 Q2 Medicine
Andrew Chiagozie Ekwesianya, Boluwatife Oladapo Ayantunde, Abraham Abiodun Ayantunde
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引用次数: 0

Abstract

Background: The hepatobiliary system has the most associated anatomical variations in the body and they are a direct reflection of the complexity of its embryological development. The anatomical pattern commonly described as 'normal' occurs only in 57-72% of the population. The objective of the study is to review the English Language published literature on the prevalence of the anatomical extra-hepatic biliary system variations and their potential implications for surgical and endoscopic procedures. This will assist both practicing and trainee surgeons in preventing biliary tract injuries while operating in this area.

Methodology: A comprehensive literature search was conducted using the PICO framework across SCOPUS, PubMed, MEDLINE, and Cochrane databases. Study characteristics and relevant data were collated. The prevalence of the most clinically important anatomical variations is presented.

Results: Seventy studies, encompassing 17,207 subjects, were included: 27 studies (9,738 subjects) on cystic duct variations, 17 studies (2,633 subjects) on gallbladder variations, and 26 studies (4,836 subjects) on cystic artery variations. Notable findings include low insertion (11.2%), medial insertion (9.8%), and parallel course (7.4%) of the cystic duct, Hartmann's pouch in 12.2% of gallbladders, and the cystic artery originating from the right hepatic artery in 83.6% or other sources in 16.4%. Moynihan's hump of the right hepatic artery was found in 1.8%.

Conclusion: These variations are frequent and surgically relevant. Understanding them is critical to avoiding complications. Employing the critical view of safety in laparoscopic cholecystectomy ensures proper visualization of anatomical structures, reducing the risk of injury.

肝外胆道系统解剖变异的警示故事及其对外科手术的影响:系统的文献回顾。
背景:肝胆系统在人体中具有最相关的解剖变异,它们是其胚胎发育复杂性的直接反映。通常被描述为“正常”的解剖模式只发生在57-72%的人群中。本研究的目的是回顾已发表的关于肝外胆道系统解剖变异的流行程度及其对外科和内窥镜手术的潜在影响的英文文献。这将有助于实习医生和实习医生在这个区域操作时防止胆道损伤。方法:使用PICO框架在SCOPUS、PubMed、MEDLINE和Cochrane数据库中进行全面的文献检索。整理研究特点及相关资料。流行的最重要的临床解剖变异提出。结果:纳入70项研究,共17,207名受试者:27项研究(9,738名受试者)关于囊管变异,17项研究(2,633名受试者)关于胆囊变异,26项研究(4,836名受试者)关于囊动脉变异。值得注意的发现包括胆囊导管的低位插入(11.2%)、内侧插入(9.8%)和平行插入(7.4%),哈特曼囊(12.2%),起源于右肝动脉的胆囊动脉占83.6%,其他来源的胆囊动脉占16.4%。右肝动脉Moynihan隆起的发生率为1.8%。结论:这些变异是常见的,与手术有关。理解它们对于避免并发症至关重要。在腹腔镜胆囊切除术中采用安全的关键视角,可以确保解剖结构的正确可视化,降低损伤的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Surgical and Radiologic Anatomy
Surgical and Radiologic Anatomy Medicine-Pathology and Forensic Medicine
CiteScore
2.40
自引率
14.30%
发文量
0
期刊介绍: Anatomy is a morphological science which cannot fail to interest the clinician. The practical application of anatomical research to clinical problems necessitates special adaptation and selectivity in choosing from numerous international works. Although there is a tendency to believe that meaningful advances in anatomy are unlikely, constant revision is necessary. Surgical and Radiologic Anatomy, the first international journal of Clinical anatomy has been created in this spirit. Its goal is to serve clinicians, regardless of speciality-physicians, surgeons, radiologists or other specialists-as an indispensable aid with which they can improve their knowledge of anatomy. Each issue includes: Original papers, review articles, articles on the anatomical bases of medical, surgical and radiological techniques, articles of normal radiologic anatomy, brief reviews of anatomical publications of clinical interest. Particular attention is given to high quality illustrations, which are indispensable for a better understanding of anatomical problems. Surgical and Radiologic Anatomy is a journal written by anatomists for clinicians with a special interest in anatomy.
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