Preoperative Evaluation and Management of Accessory Hepatic Ducts for Cholecystectomy

Abstract

Purpose: The aim of this study was to assess the diagnostic accuracy of preoperative images in detecting accessory hepatic ducts and frequency of bile duct injuries. Materials and Methods: A total of 482 patients were treated consecutively with cholecystectomy for gallbladder disease during a recent 10-year period. In this case, 36 patients (7.5%) were given a diagnosis of accessory hepatic ducts, and we reviewed their preoperative evaluation of hepatic ducts, operative procedure and the rate of hepatic duct injuries and compared them with normal anatomy groups. Results: Type I, II, III, IV, and V accessory hepatic ducts were detected in 2, 6, 26, 0, and 2 patients, respectively, based on the Hisatsugu classification, draining posterior segments in up to 80% of cases. The accuracy for detecting accessory hepatic ducts was 89.3% (25 out of 28 patients) for magnetic resonance cholangiograph (MRC) and 100% (15 patients) for drip infusion cholangiographic-CT (DIC-CT), respectively. In accessory hepatic duct groups, laparotomy was performed in 7 patients (19.4%), laparoscopy in 29 patients (80.6%), with conversion to laparotomy in 3 patients (10.3%). Laparotomy was performed more in accessory hepatic duct groups than normal anatomy groups, but there was no significant difference in the conversion rate to laparotomy. None of the patients with accessory hepatic ducts suffered bile duct injuries, postoperative obstructions of hepatic ducts or remnant gallbladder stones. Conclusion: A detailed evaluation of hepatic ducts on preoperative precise imaging studies was necessary to perform safe laparoscopic cholecystectomy, and surgical techniques such as intraoperative cholangiography could be considered in operations for accessory hepatic duct groups.