The cases of cholelithiasis with accessory hepatic ducts joining the cystic ducts performed cholecystectomy safely avoiding bile duct injury

Abstract

The type of accessory hepatic ducts joining the cystic duct requires caution because conventional cystic duct dissection in cholecystectomy may cause bile duct injuries. We report herein three cases of cholecystectomy safely performed with various measures for cholelithiasis with an aberrant hepatic duct. Case 1: The patient with the right posterior-inferior segmental (B6) bile duct joining the cystic duct was found ineligible for cystic duct dissection during intraoperative cholangiography via an endoscopic nasobiliary drainage tube placed preoperatively. Thus, the patient was converted to laparotomy to undergo subtotal cholecystectomy. Case 2: The patient with the posterior segmental bile duct joining the cystic duct underwent laparoscopic cholecystectomy for calculous cholecystitis. The cystic duct was dissected while performing intraoperative cholangiography via percutaneous transhepatic gallbladder drainage tube. Case 3: The patient had the B6 bile duct joining the cystic duct. Laparoscopic cholecystectomy was performed by dissecting the cystic duct while confirming the bile duct running through an infrared camera following intravenous indocyanine green injection. All three patients were discharged without postoperative complications. Postoperative DIC-CT confirmed preservation of the accessary hepatic ducts.