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The cystohepatic ducts: surgical implications

Les conduits hépato-cystiques. Conséquences chirurgicales

  • Radiologic Anatomy
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Summary

The cystohepatic ducts (CHDs) drain the entirety of a hepatic territory of variable extent into the cystic duct or gallbladder (cholecystohepatic ducts). Certain very rare patterns of the CHDs constitute anomalies but as a rule a CHD represents one of the numerous variants of division of the extrahepatic bileducts. Their existence is explained by the normal anatomic development of the bile-ducts. They are usually discovered during peroperative cholangiography performed during cholecystectomy for gallstones. Their actual incidence is small: 1–2 % of cases. A CHD was found by the authors on 12 occasions in a total of 1410 cholecystectomies (0.9 %). The CHDs are always bile ducts of the right lobe of the liver and may drain a subsegment or segment, a sector or, exceptionally, the whole of the right lobe of the liver. Peroperative cholangiography does not always allow distinction of the CHDs from other and equally rare variants of division of the extrahepatic bile-ducts, whose existence carries the same practical implications. The existence of the CHDs is unpredictable. Their position renders them particularly vulnerable during cholecystectomy and the serlousness of an accidental injury of a CHD depends on the extent of the hepatic territory it drains. Strict observance of the rules of biliary surgery and routine peroperative cholangiography should preserve the integrity of CHDs draining an extensive hepatic territory.

Résumé

Les conduits hépato-cystiques (CHC) sont des conduits biliaires qui drainent dans le conduit cystique ou dans la vésicule biliaire la totalité d'un territoire hépatique de dimension variable selon les cas. Certaines dispositions rarissimes des CHC constituent des anomalies. Mais, en règle générale, les CHC représentent l'une des nombreuses variations de division des conduits biliaires extra-hépatiques. L'organogénèse et l'anatomie comparée permettent d'expliquer leur existence et montrent que les CHC résultent d'un développement anatomique normal des voies biliaires. Les CHC sont découverts le plus souvent grâce à la cholangiographie per-opératoire, pratiquée au cours de la cholécystectomie pour lithiase biliaire. La fréquence réelle des CHC est faible: 1 % à 2 % des cas. Sur un total de 1410 cholécystectomies pour lithiase biliaire, les auteurs ont rencontré 12 fois un CHC (0,9 %). Les CHC sont toujours des conduits biliaires du foie droit. Ils peuvent drainer: un soussegment ou un segment, un secteur, ou, tout à fait exceptionnellement, la totalité du foie droit. La cholangiographie per-opératoire ne permet pas toujours de distinguer les CHC d'autres variations de division des conduits biliaires extra-hépatiques tout aussi rares, dont l'existence détermine les mêmes conséquences pratiques que les CHC. L'existence des CHC est imprévisible. La situation des CHC les rend particulièrement vulnérables au cours de la cholécystectomie. La gravité de la lésion accidentelle d'un CHC dépend de l'étendue du territoire hépatique qu'il draine. L'application stricte des règles de la chirurgie biliaire et d'un protocole de cholangiographie peropératoire doit permettre de préserver les CHC qui drainent un territoire hépatique étendu.

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Authors and Affiliations

  1. Department of Anatomy, Faculty of Medicine of Grenoble, F-38700, La Tronche, France

    J Champetier, I Alnaasan & B Charvin

  2. Department of General and Gastrointestinal Surgery, CHU de Grenoble, BP 217 X, F-38043, Grenoble Cedex, France

    J Champetier, C Létoublon, I Alnaasan & B Charvin

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  1. J Champetier
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  2. C Létoublon
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  3. I Alnaasan
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Champetier, J., Létoublon, C., Alnaasan, I. et al. The cystohepatic ducts: surgical implications. Surg Radiol Anat 13, 203–211 (1991). https://doi.org/10.1007/BF01627988

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