The cystohepatic ducts: surgical implications

Abstract

The cystohepatic ducts (CHDs) drain the entirety of a hepatic territory of variable extent into the cystic duct or gallbladder (cholecystohepatic ducts). Certain very rare patterns of the CHDs constitute anomalies but as a rule a CHD represents one of the numerous variants of division of the extrahepatic bile-ducts. Their existence is explained by the normal anatomic development of the bile-ducts. They are usually discovered during peroperative cholangiography performed during cholecystectomy for gallstones. Their actual incidence is small: 1-2% of cases. A CHD was found by the authors on 12 occasions in a total of 1410 cholecystectomies (0.9%). The CHDs are always bile ducts of the right lobe of the liver and may drain a subsegment or segment, a sector or, exceptionally, the whole of the right lobe of the liver. Peroperative cholangiography does not always allow distinction of the CHDs from other and equally rare variants of division of the extrahepatic bile-ducts, whose existence carries the same practical implications. The existence of the CHDs is unpredictable. Their position renders them particularly vulnerable during cholecystectomy and the seriousness of an accidental injury of a CHD depends on the extent of the hepatic territory it drains. Strict observance of the rules of biliary surgery and routine peroperative cholangiography should preserve the integrity of CHDs draining an extensive hepatic territory.