Anatomic Consideration of the Cystic Artery during Open Cholecystectomy

Abstract

The cystic artery is one of the most anomalous structures in the body. The so-called "normal" cystic artery is found in about 60% of the cases and a number of anatomical variations are found during cholecystectomy. It is important in laparoscopic cholecystectomy that a surgeon should be familiar with such anatomical variations. During cholecystectomy careful dissections should be done to clarify the course of the cystic artery in relation to the cystic duct, bile duct and right hepatic artery Anatomical variations of cystic artery in one hundred patients who underwent cholecystectomy were analyzed. Cholecystectomy was done the biliary stones in 76 cases, and in 24 cases, cholecystectomy was done because of malignant disease of biliary tract. The cystic artery was found in the hepatocystic triangle in 54 cases. In 11 patients, the artery was juxtaposition of cystic duct and in 25 cases, both cystic artery and right hepatic artery were found in the triangle. The artery were not found in the hepatocystic triangle in 10 cases Seventy nine arteries arose from the right hepatic artery and 15 from the proper hepatic artery. The origin could not be identified in 6 cases. In 70 cases, the cystic artery ran posterior to the common bile duct but in 24 cases, it crossed the anterior surface of the common bile duct. The surgical anatomy of the biliary tree is extremely important. The biliary tree is the most anomalous structure in the human body and surgeon must be aware of any kind of variation during the biliary operation.