Complications of laparoscopic cholecystectomy in relation to the normal anatomy and variations in the extrahepatic biliary tree and vascular anatomy:A Cross-sectional Study

​Cholecystectomy is one of the most frequent surgical  procedures performed as of today.The first successful open cholecystectomy was done in 1882 by Carl Langenbuch.

Philippe Mouret introduced laparoscopic cholecystectomy in France in 1987 and it quickly revolutionized the treatment of gallstone disease. It superseded open cholecystectomy, and ended attempts for non-invasive management of gallstones such as extracorporeal shock wave or cholangioscopic lithotripsy and medical therapies such as bile salts.

  â€‹Currently laparoscopic cholecystectomy is done for gallstones diseases like symptomatic gallstones, porcelain gallbladder, acute cholecystitis,  choledocholithiasis  and gallstone pancreatitis.It is also done for the other benign diseases of the biliary tree and gallbladder like biliary dyskinesia, acalculous cholecystitis and early stages of carcinoma gallbladder.

  â€‹Laparoscopic cholecystectomy has emerged as a safe and effective treatment for  multiple gallbladder diseases due to its advantages like : early return of bowel function, shorter duration of hospital stay, small incision, cosmetic satisfaction, low post operative pain, cost effectiveness and early return to full activity.

  â€‹Laparoscopic cholecystectomy involves removal of the gall bladder by placement of multiple laparoscopic ports in the abdomen and creation of pneumoperitoneum. The critical view of safety is visualised by clearing the hepatocystic and Calot’striangle.  In the critical view of safety the cystic duct and cystic artery can be seen entering the gallbladder which are then clipped. Once the cystic artery and the cystic duct are clipped the gall bladder is removed of the liver bed and taken out through the laparoscopic port. Thus during laparoscopic cholecystectomy correct identification of the anatomy the gall bladder, hepatoduodenal ligament, Calot’s triangle, hepatocystic triangle, cystic artery and cystic duct is crucial.

However classical description of the anatomy of extra hepatic biliary tree and its arteries is seen only in one out of three people. Variations in the extrahepatic biliary tree and vascular anatomy are the norm rather than an exception.

 â€‹Following laparoscopic cholecystectomy complications like wound infection, cardiovascular difficulties, retained stones, biliary leak, and conversion to open cholecystectomy are seen.6Variations in the extrahepatic biliary duct’s architecture have been linked to unintentional injury to biliary duct during laparoscopic cholecystectomy.7 Variations in the anatomy of vascular structures supplying the gall bladder and the extra hepatic biliary tree have been associated with increased rates of complications like excessive bleeding and conversion to open cholecystectomy.

  â€‹Despite laparoscopic cholecystectomy being the most commonly performed procedure worldwide, there are amultitude of complications with this procedure including those with variations in the gross and vascular anatomy of the gallbladder and extrahepatic biliary tree. Even though many anatomists and surgeons have documented the anomalies of the vascular and extrahepatic biliary tree, only few research publications have documented the operative and post operative complications for these variations, thus the need for this study.