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Variations in the cystic duct: frequency and the relationship among insertion sides and heights on the bile duct

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Abstract

Background

Evaluation of the cystic duct anatomy prior to bile duct or gallbladder surgery is important, to decrease the risk of bile duct injury. This study aimed to clarify the frequency of cystic duct variations and the relationship between them.

Methods

Data of 205 patients who underwent cholecystectomy after imaging at Sada Hospital, Japan, were analyzed. The Chi-square test was used to analyze the relationships among variations.

Results

The lateral and posterior sides of the bile duct were the two most common insertion points (92 patients, 44.9%), and the middle height was the most common insertion height (135 patients, 65.9%). Clinically important variations (spiral courses, parallel courses, low insertions, and right hepatic duct draining) relating to the risk of bile duct injury were observed in 24 patients (11.7%). Regarding the relationship between the insertion sides and heights, we noticed that the posterior insertion frequently existed in low insertions (75.0%, P < 0.001) and did not exist in high insertions. In contrast, the anterior insertion coexisted with high and never low insertions. Spiral courses have two courses: anterior and posterior, and anterior ones were only found in high insertion cases.

Conclusions

The insertion point of the cystic duct and the spiral courses tended to be anterior or lateral superiorly and posterior inferiorly. Clinically significant variations in cystic duct insertions are common and surgeons should be cautious about these variations to avoid complications.

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Data availability

There are ethical restrictions on sharing an original anonymized data set, because the data contain potentially identifying patient information; origin of patients and operation dates. After the approval of the IRB, the data can be provided. Contact the corresponding author, Kenji Fujiwara.

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Acknowledgements

The authors acknowledge and appreciate the academic support from the Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University. The authors would like to thank Editage (www.editage.com) for English language editing.

Funding

Kenji Fujiwara was supported by KAKENHI under Grant JP20K22817 from the Japan Society for the Promotion of Science. (https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT20K22817/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Kenji Fujiwara

    Present address: Department of Surgery, Kimura Hospital, Fukuoka, Japan

  2. Atsushi Abe

    Present address: Department of Surgery, Shin-Kokura Hospital, Kitakyushu, Japan

  3. Tatsuya Hirano

    Present address: Department of Surgery, Yagi Hospital, Fukuoka, Japan

Authors and Affiliations

  1. Department of Surgery, Sada Hospital, Fukuoka, Japan

    Kenji Fujiwara, Atsushi Abe, Toshihiro Masatsugu, Tatsuya Hirano & Masayuki Sada

  2. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Kenji Fujiwara & Koji Shindo

  3. Department of Radiology, Sada Hospital, Fukuoka, Japan

    Kiyohisa Hiraka

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Contributions

Conceptualization and data analysis, KF and KH; data curation, KF, AA, TM, TH, and MS; writing, KF, KH, and SK; supervision, MS. All authors reviewed the manuscript.

Corresponding author

Correspondence to Kenji Fujiwara.

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Conflict of interests

Kenji Fujiwara had consulting fee from Beacon Group Inc., and holds shares at Vanguard. The other authors have declared that no competing interests exist.

Ethical approval

The research was performed in accordance with the Declaration of Helsinki. All data were fully anonymized before the assessment. Our own institutional review board (IRB), Sada Hospital IRB, reviewed and ethically approved the study for the reference of the database and medical records for research purposes. The IRB waived the requirement for informed consent (IRB approval number: S190726-1). Contact form (https://www.sada.or.jp/contact/).

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Fujiwara, K., Hiraka, K., Shindo, K. et al. Variations in the cystic duct: frequency and the relationship among insertion sides and heights on the bile duct. Surg Radiol Anat 46, 223–230 (2024). https://doi.org/10.1007/s00276-023-03275-9

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