A cautionary tale of anatomical variations of the extrahepatic biliary system and their implications for surgical procedures: a systematic literature review.
Andrew Chiagozie Ekwesianya, Boluwatife Oladapo Ayantunde, Abraham Abiodun Ayantunde
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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.
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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