Extrahepatic Biliary Tract Anatomy: A Review

Abstract

Laparoscopic cholecystectomy is one of the most common surgical procedures in general surgery. Significant gaps in knowledge still exist and even with clinical expertise, there might be limitations. Some of these are exploration restrictions during laparoscopic approach, visualization impairments and distortion of the usual arrangement of structures because of local inflammation, among others. Given the wide variability in anatomical presentation and considering that even in 56% of the population there is a close relationship to main vascular structures, intraoperative injuries might occur leading to higher rates of complications, longer surgical time and increased morbidity. Our aim is to describe the most common and relevant anatomic variations in the extrahepatic biliary tract (EBT). A systematic review of the literature was pursued using the MeSH terms: “Biliary Tract/abnormalities”, “Bile Ducts and Extrahepatic/abnormalities”. Only articles written in Spanish and English and limited to the last 20 years were considered. The anatomical structure considered normal for the EBT is described in roughly 60% of the population. The most variable structures according to included manuscripts are the left and right biliary ducts and the most prevalent variations are: posterior branch of the right hepatic duct draining into the left hepatic duct, triple confluence of the intrahepatic ducts, and anterior or posterior branch of the right hepatic duct draining into the common hepatic or cystic duct. As mentioned before the awareness and comprehension of EBT variations is crucial in avoiding complication, morbidity and achieving optimal outcomes in diagnostics and therapeutic procedures as reducing intraoperative iatrogenic injuries and considering the need of noninvasive techniques for EBT identification for a better surgical planning.