open access
Variations in extra-hepatic biliary tree morphology and morphometry: a narrative review of literature with focus on cystohepatic triangle
, 1, 2, 2, 3456, 7
Affiliations- Department of Anatomy, All India Institute of Medical Sciences, Phulwarisharif, Patna, India
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, United States
- Department of Neurosurgery, Tulane Centre for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, United States
- Dental and Oral Medical Centre, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Department of Anatomical Sciences, St. George’s University, Grenada, West Indies
open access
Abstract
The morphometry and morphology of the components of extrahepatic biliary tree
show extensive variations. A beforehand recognition of these variations is very
crucial to prevent unintended complications while performing surgeries in this
region. This study was conducted to analyse the configuration of the extrahepatic
biliary tree and its possible variations, as well as measure the components that
limit the cystohepatic triangle. Articles were searched in major online indexed
databases (Medline and PubMed, Scopus, Embase, CINAHL Plus, Web of Science
and Google Scholar) using relevant key words. A total of 73 articles matched
the search criteria of which 55 articles were identified for data extraction. The
length of left and right hepatic duct in majority of studies was found to be
> 10 mm. A wide range of diameters of hepatic ducts were observed between
5 and 43 mm. The average length of cystic duct is around 20 mm. The length and
diameter of the common bile duct are 50–150 mm and 3–9 mm, respectively.
The most frequently observed pattern of insertion of cystic duct into common
hepatic duct is right lateral, rarely anterior, or posterior spiral insertion can present.
The results of this study will provide a standard reference range which instead
will help to differentiate the normal and pathological conditions.
Abstract
The morphometry and morphology of the components of extrahepatic biliary tree
show extensive variations. A beforehand recognition of these variations is very
crucial to prevent unintended complications while performing surgeries in this
region. This study was conducted to analyse the configuration of the extrahepatic
biliary tree and its possible variations, as well as measure the components that
limit the cystohepatic triangle. Articles were searched in major online indexed
databases (Medline and PubMed, Scopus, Embase, CINAHL Plus, Web of Science
and Google Scholar) using relevant key words. A total of 73 articles matched
the search criteria of which 55 articles were identified for data extraction. The
length of left and right hepatic duct in majority of studies was found to be
> 10 mm. A wide range of diameters of hepatic ducts were observed between
5 and 43 mm. The average length of cystic duct is around 20 mm. The length and
diameter of the common bile duct are 50–150 mm and 3–9 mm, respectively.
The most frequently observed pattern of insertion of cystic duct into common
hepatic duct is right lateral, rarely anterior, or posterior spiral insertion can present.
The results of this study will provide a standard reference range which instead
will help to differentiate the normal and pathological conditions.
Keywords
extrahepatic biliary tree, cystic duct, morphometry, morphology, cystohepatic triangle
About this articleTitle
Variations in extra-hepatic biliary tree morphology and morphometry: a narrative review of literature with focus on cystohepatic triangle
Journal
Issue
Article type
Review article
Pages
498-506
Published online
2022-07-28
Page views
1020
Article views/downloads
686
DOI
Pubmed
Bibliographic record
Folia Morphol 2023;82(3):498-506.
Keywords
extrahepatic biliary tree
cystic duct
morphometry
morphology
cystohepatic triangle
Authors
A. Priya
S. K. Ghosh
J. A. Walocha
A. Pasternak
J. Iwanaga
M. Loukas
References (58)- Aljiffry M, Abbas M, Wazzan MAM, et al. Biliary anatomy and pancreatic duct variations: a cross-sectional study. Saudi J Gastroenterol. 2020 [Epub ahead of print]; 26(4): 188–193.
- Anson B, Mcvay CB. Surgical anatomy. 5th ed. WB Saunders Co., Philadelphia 1971.
- Awazli LG. Anatomical variations of extrahepatic biliary system. Iraqi J Med Sci. 2013; 11: 258–264.
- Ayuso JR, Ayuso C, Bombuy E, et al. Preoperative evaluation of biliary anatomy in adult live liver donors with volumetric mangafodipir trisodium enhanced magnetic resonance cholangiography. Liver Transpl. 2004; 10(11): 1391–1397.
- Babu CS, Sharma M. Biliary tract anatomy and its relationship with venous drainage. J Clin Exp Hepatol. 2014; 4(Suppl 1): S18–S26.
- Benson EA, Page RE. A practical reappraisal of the anatomy of the extrahepatic bile ducts and arteries. Br J Surg. 1976; 63(11): 853–860.
- Blidaru D, Blidaru M, Pop C, et al. The common bile duct: size, course, relations. Rom J Morphol Embryol. 2010; 51(1): 141–144.
- Cachoeira E, Rivas A, Gabrielli C. Anatomic variations of extrahepatic bile ducts and evaluation of the length of ducts composing the cystohepatic triangle. Int J Morphol. 2012; 30(1): 279–283.
- Cao J, Ding X, Wu H, et al. Classification of the cystic duct patterns and endoscopic transpapillary cannulation of the gallbladder to prevent post-ERCP cholecystitis. BMC Gastroenterol. 2019; 19(1): 139.
- Chen D, Fei Z, Huang X, et al. Transcystic approach to laparoscopic common bile duct exploration. JSLS. 2014; 18(3).
- Choi JY, Kim MJ, Lee JM, et al. Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol. 2008; 191(5): 1448–1457.
- Couinaud C. Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig Surg. 1999; 16(6): 459–467.
- Deenitchin GP, Yoshida J, Chijiiwa K, et al. Complex cystic duct is associated with cholelithiasis. HPB Surg. 1998; 11(1): 33–37.
- Deka P, Islam M, Jindal D, et al. Analysis of biliary anatomy according to different classification systems. Indian J Gastroenterol. 2014; 33(1): 23–30.
- Dowdy GS, Waldron GW, Brown WG. Surgical anatomy of the pancreatobiliary ductal system. Observations. Arch Surg. 1962; 84: 229–246.
- Eftekhar V, Shams AA, Jamalizade M. A study of the anatomic variations in extrahepatic bile ducts in 50 adults referred to Kerman forensic medicine organization. Anat Sci J. 2013; 10: 57–62.
- Elgasim R, Abukonna A, Elgyoum A, et al. Measurement of the diameter of the common bile duct and pancreatic duct among healthy adult sudanese subjects using magnetic resonance cholangiopancreatography. Int J Biomed. 2020; 10(4): 392–396.
- El-Haddad J, Štrkalj G, Pather N. A global perspective on embryological and fetal collections: Where to from here? Anat Rec (Hoboken). 2022; 305(4): 869–885.
- Ferrari R. Writing narrative style literature reviews. Med Writ. 2015; 24(4): 230–235.
- Ferris DO, Vibert JC. The common bile duct: significance of its diameter. Ann Surg. 1959; 149(2): 249–251.
- Graham MF, Cooperberg PL, Cohen MM, et al. The size of the normal common hepatic duct following cholecystectomy: an ultrasonographic study. Radiology. 1980; 135(1): 137–139.
- Gregory AT, Denniss AR. An introduction to writing narrative and systematic reviews: tasks, tips and traps for aspiring authors. Heart Lung Circ. 2018; 27(7): 893–898.
- Gündüz N, Doğan M, Alacagöz M, et al. Anatomical variations of cystic duct insertion and their relationship with choledocholithiasis: an MRCP study. Egypt J Radiol Nuclear Med. 2021; 52(1).
- Hand B. Anatomy and function of the extrahepatic biliary system. Clin Gastroenterol. 1973; 2(1): 3–29.
- Hayes MA, Goldenberg IS, Bishop CC. The developmental basis for bile duct anomalies. Surg Gynecol Obstet. 1958; 107(4): 447–456.
- Healey JE, Schroy PC. Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branchings and the major variations of the biliary ducts. AMA Arch Surg. 1953; 66(5): 599–616.
- Hollinshed WH. Anatomy for Surgeons. Vol. 2. 2nd ed. Harper and Row, New York 1971: 345–362.
- Horrow MM, Horrow JC, Niakosari A, et al. Is age associated with size of adult extrahepatic bile duct: sonographic study. Radiology. 2001; 221(2): 411–414.
- Iwanaga J, Singh V, Ohtsuka A, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
- Khan AS, Shah Z. Anatomical variations of cystic duct encountered during open cholecystectomy. Kmuj. 2012; 4: 19–22.
- Khatiwada S, Adhikari BN, Shakya S. Cadaveric study on the length and diameter of the hepatic ducts. Int J Health Sci Res. 2017; 7: 46–51.
- Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc. 2002; 55(7): 889–896.
- Leslie D. The width of the common bile duct. Surg Gynecol Obstet. 1968; 126(4): 761–764.
- Liechtenstein ME, Ivy AC. The function of the “valves” of Heister. Surgery. 1937; 1: 38–53.
- Mahour GH, Wakim KG, Ferris DO. The common bile duct in man: its diameter and circumference. Ann Surg. 1967; 165(3): 415–419.
- Michels N. Blood supply and anatomy of the upper abdominal organs, with a descriptive atlas. Lippincott 1955.
- Mortelé KJ, Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications. AJR Am J Roentgenol. 2001; 177(2): 389–394.
- Nigam G, Lalwani R, Babu CSR, et al. Surgical anatomy of sub-hepatic biliary system. J Anat Soc India. 2014; 63(1): 48–51.
- Pavlidis TE, Triantafyllou A, Psarras K, et al. Long, parallel cystic duct in laparoscopic cholecystectomy for acute cholecystitis: the role of magnetic resonance cholangiopancreatography. JSLS. 2008; 12(4): 407–409.
- Peng R, Zhang L, Zhang XM, et al. Common bile duct diameter in an asymptomatic population: A magnetic resonance imaging study. World J Radiol. 2015; 7(12): 501–508.
- Piyawong W, Lekhavat V. Normal measurement of diameters of the common bile ducts in different aged groups. J Med Assoc Thai. 2016; 99(Suppl 4): S153–S158.
- Qamar N, Ishaque I, Ilyas A, et al. Identification of cystic duct variations in laparoscopic visual field. Pak J Surg. 2016; 32: 96–99.
- Rajguru J, Dave M. The morphological aberrations of cystic duct and its clinical significance: a gross anatomical study. Int J Anat Res. 2018; 7: 2008–2013.
- Sah SK, Pant H, Wang YX. Morphometric analysis of common bile duct: a cadaveric study. J Biomed Res Environmental Sci. 2021; 2(2): 064–068.
- Salih AM, Kakamad FH, Mohammed SH, et al. Double cystic duct, a review of literature with report of a new case. Int J Surg Case Rep. 2017; 38: 146–148.
- Sangameswaran K. Variations of cystic duct and its clinical significance. Int J Anat Res. 2021; 9(4): 8120–8126.
- Sarawagi R, Sundar S, Gupta SK, et al. Anatomical variations of cystic ducts in magnetic resonance cholangiopancreatography and clinical implications. Radiol Res Pract. 2016; 2016: 3021484.
- Senturk S, Miroglu TC, Bilici A, et al. Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT. Eur J Radiol. 2012; 81(1): 39–42.
- Shambhu Nath J, Omar S. Anatomical variation in extrahepatic biliary apparatus. Acad Anat Int. 2020; 6(2): 25–28.
- Sirisha V, Udaya KP, Naveen K, et al. A study on the variations in cystic duct: clinical and embryological evaluation. Int J Anat Res. 2017; 5(3.2): 4308–4312.
- Sobha DT, Krishna PH, Devi TS. The study of variations of extra-hepatic biliary apparatus. IOSR J Dent Med Sci. 2013; 5(5): 25–31.
- Sureka B, Bansal K, Patidar Y, et al. Magnetic resonance cholangiographic evaluation of intrahepatic and extrahepatic bile duct variations. Indian J Radiol Imaging. 2016; 26(1): 22–32.
- Taourel P, Bret PM, Reinhold C, et al. Anatomic variants of the biliary tree: diagnosis with MR cholangiopancreatography. Radiology. 1996; 199(2): 521–527.
- Tellez BS, Gomez EC, Porras PF, et al. Morphological expression of the extrahepatic bile duct. A study in a sample of Colombian mestizo population. Int Arch Med. 2018; 11.
- Turner MA, Fulcher AS. The cystic duct: normal anatomy and disease processes. Radiographics. 2001; 21(1): 3–22.
- Vakili K, Pomfret EA. Biliary anatomy and embryology. Surg Clin North Am. 2008; 88(6): 1159–1174.
- Worku MG, Enyew EF, Desita ZT, et al. Sonographic measurement of normal common bile duct diameter and associated factors at the University of Gondar comprehensive specialized hospital and selected private imaging center in Gondar town, North West Ethiopia. PLoS One. 2020; 15(1): e0227135.
- Yamakawa T, Zhang T, Midorikawa Y, et al. A case of cystic duct drainage into the left intrahepatic duct and the importance of laparoscopic fundus-first cholecystectomy for prevention of bile duct injury. J Laparoendosc Adv Surg Tech A. 2007; 17(5): 662–665.
