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. 2011 Aug;43(2):67-72.
doi: 10.5152/eajm.2011.16.

Six rare biliary tract anatomic variations: implications for liver surgery

Daniel V Kostov  1 , Georgi L Kobakov  2
Affiliations

Six rare biliary tract anatomic variations: implications for liver surgery

Daniel V Kostov et al. Eurasian J Med. 2011 Aug.

Abstract
in English, Turkish

Objective: The variations in the anatomy of the biliary tract need to be recognized in modern liver surgery. The purpose of this clinical and anatomical study is to describe several novel biliary tract variations and to outline their practical importance for liver resections and transplantations.

Materials and methods: Over the previous 10 years, the anatomic variations of the bile ducts were examined during 600 intraoperative cholangiographies, 104 segmentectomies and 54 hemihepatectomies in patients with liver diseases. The intraoperative anatomies of the right and left hepatic ducts and the common hepatic duct confluence were analyzed.

Results: Twenty-two variations occurred in 59.5% of the patients. Six variations were described for the first time: an accessory right hepatic duct in which a cystic duct drained; a tetrafurcation from the right anterior hepatic duct, right posterior hepatic duct and bile ducts for Segments 2 and 3 with aberrant bile drainage from Segment 4 into the bile duct for Segment 8; an aberrant bile drainage from Segments 6 and 7 into the common hepatic duct; an accessory bile duct for Segment 6 that drained into the bile duct for Segment 3; a tetrafurcation from the right anterior hepatic duct and the bile ducts for Segments 6, 3 and 2 with bile from Segment 7 draining into the bile duct for Segment 2; and an accessory bile duct for the left hemiliver that drained bile from the Type 4 small accessory hepatic lobe (according to Caygill & Gatenby) into the common hepatic duct.

Conclusion: These newly described biliary tract variations should be recognized by liver surgeons to avoid unwanted postoperative complications.

Amaç: Safra yolları anatomisi içinde farklılıkların, modern karaciğer cerrahisinde tanınması gerekir. Bu klinik ve anatomik çalışmanın amacı, birkaç yeni safra yolları değişimini tanımlamak ve karaciğer rezeksiyonları ve nakli için pratik öneminin altını çizmektir.

Gereç ve yöntem: Bundan önceki on yılda, safra kanallarının anatomik varyasyonlu karaciğer hastalığı olanlarda 600 intraoperatif kolanjiografi, 104 segmentektomi ve 54 hemihepatektomi incelendi. Sağ ve sol hepatik kanalların intraoperatif anatomileri ve ortak hepatik kanal kavşakları analiz edildi.

Bulgular: Hastaların %59.5’da yirmi iki kanal varyasyonu gözlemlenmiştir. Altı varyasyon ilk kez tarif edilmiştir: bir sistik kanala drene olan bir aksesuar sağ hepatik kanal; Segment 4 anormal safra drenajı ile 2 ve 3 segmentleri için sağ anterior hepatik kanal, sağ posterior hepatik kanal ve safra yolları bir tetrafurkasyon içine segment 8 safra kanalı; segment 6 ve 7’den ortak hepatik kanal içine bir anormal safra drenajı; segment 3 safra kanalı içine drene olan segment 6 için bir aksesuar safra kanalı, sağ anterior hepatik kanal bir tetrafurkasyon ve safra segmentleri 6, 3 ve segment 2 safra kanalına drene segment 7 ile 2 safra kanalları ve sol hemiliver için bir aksesuar safra kanalına drene safra bu Tip 4 küçük aksesuar karaciğer lobu (Caygill & Gatenby’a göre) içine ortak hepatik kanal.

Sonuç: Bu yeni tanımlanan safra yolları varyasyonları istenmeyen ameliyat sonrası komplikasyonları önlemek için karaciğer cerrahları tarafından göz önünde bulundurulmalıdır.

Keywords: Bile ducts; Biliary tract variations; Cholangiography; Hepatectomy; Liver segments.

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Figures

Figure 1.
Figure 1.
Six rare anatomic bile duct variations. Accessory hepatic lobe (AHL).
Figure 2.
Figure 2.
Accessory RHD (1) in which a CD drains. Both the RHD and LHD form the CHD.
Figure 3.
Figure 3.
A) Tetrafurcation formed by the RAHD, RPHD, and biliary ducts for Sg2 and Sg3 with aberrant bile drainage from Sg4 into the biliary duct for Sg8. B) Aberrant bile drainage from Sg6 and Sg7 into the CHD.
Figure 4.
Figure 4.
A) Accessory bile duct for Sg6 that drains into the bile duct for Sg3. B) Tetrafurcation formed by the RAHD and bile ducts for Sg6, Sg3 and Sg2 with bile from Sg7 draining into the bile duct for Sg2.
Figure 5.
Figure 5.
A) Small accessory hepatic lobe (1) attached to the main liver by a mesentery (2). B) Accessory bile duct (1) for the left hemiliver that drains the small accessory hepatic lobe.
See this image and copyright information in PMC

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