title: Anatomical variations and congenital anomalies of extra hepatic biliary system encountered during laparoscopic cholecystectomy.
abstract: OBJECTIVE
  To assess the frequency of anatomical variations of extrahepatic biliary system in patients undergoing laparoscopic cholecystectomy.
  
  
  METHODS
  This is an observational study performed in the Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro for a period of four years from January 2004 to December 2007. All diagnosed patients of cholelithiasis undergoing routine laparoscopic cholecystectomy were assessed for anatomical/congenital extra hepatic biliary and vascular anomalies. Structures mainly assessed for anomalies were gall bladder, cystic duct, supraduodenal part of Common Bile Duct (CBD), cystic artery and hepatic artery which are routinely handled during laparoscopy. However, assessment of variations and anomalies, of hepatic ducts, portal vein, retroduodenal and pancreatic parts of CBD were not done due to possibility of iatrogenic injuries.
  
  
  RESULTS
  Three hundred cases of cholelithiasis comprising 255 (85%) females and 45 (15%) males with mean age of 39.85 +/- 18.82 years were included in the study. Patients mainly presented with upper abdominal pain including pain in right hypochondrium (71.67%), pain in right hypochondrium and epigastrium (19%) and pain in epigastrium alone (9.33%) as main symptoms. Operative findings revealed variations in 61 (20.33%) patients mainly involving cystic artery (10.67%), cystic duct (4.33%), right hepatic artery (2.67%) and gallbladder (2%). Postoperatively 3.67% revealed bleeding and 1.67% biliary leak from drain as main complications related to anatomical variations giving rise to 1% morbidity, however, no mortality was seen in this series.
  
  
  CONCLUSIONS
  Congenital anomalies and normal variants of biliary tree, are not common but may be of significance during laparoscopic surgery as failure to recognize them leads to iatrogenic injuries and can increase morbidity and mortality.
authors.affiliation: Liaquat University of Medical & Health Sciences, Jamshoro, Sindh.
authors.forename: Khamiso Altaf Hussain
authors.initials: KA
authors.lastname: Talpur
authors.forename: Abdul Aziz
authors.initials: AA
authors.lastname: Laghari
authors.forename: Sikandar Azam
authors.initials: SA
authors.lastname: Yousfani
authors.forename: Arshad Mahmood
authors.initials: AM
authors.lastname: Malik
authors.forename: Aamir Iqbal
authors.initials: AI
authors.lastname: Memon
authors.forename: Sangrasi Ahmed
authors.initials: SA
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000002:abnormalities / Q000033:anatomy & histology*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult