Parallel Configuration of the Cystic and Common Hepatic Ducts: a Surgical Odyssey.

Abstract

Introduction: Laparoscopic cholecystectomy is among the most frequently performed surgical procedures worldwide; however, it carries a persistent risk of iatrogenic bile duct injury, particularly in the presence of anatomical variations. Misinterpretation of biliary anatomy remains a leading cause of serious complications, underscoring the importance of recognizing rare variants and adopting safe surgical strategies.

Case report: We report the case of a 78-year-old patient undergoing elective laparoscopic cholecystectomy for recurrent cholecystitis and cholangitis. Given the history of repeated inflammatory episodes, dense adhesions and intraoperative technical difficulties were anticipated. Intraoperatively, dense adhesions and a contracted gallbladder were encountered. Indocyanine green fluorescence imaging revealed uncertain anatomical landmarks, demonstrating a rare parallel configuration of the cystic duct and common hepatic duct. Due to unsafe conditions, conversion to open surgery was performed, allowing safe ligation of the cystic duct. The postoperative course was uneventful.

Conclusion: This case highlights the critical role of anatomical awareness, intraoperative vigilance and timely adoption of bailout strategies to ensure a safe cholecystectomy and prevent biliary injuries.