Intraoperative Variations of Cystic Artery and Duct in Laparoscopic Cholecystectomy: A Systematic Review With Meta‐Analysis

Résumé fourni par la source

BACKGROUND: Laparoscopic cholecystectomy (LC) is the gold-standard treatment for benign gallbladder disease but carries a higher risk of bile duct injury than the open approach, largely due to misidentification of critical hepatobiliary structures. This systematic review and meta-analysis synthesizes intraoperative evidence on the prevalence and surgical relevance of anatomical variations and evaluates their implications for safe LC. METHODS: Following Evidence-based Anatomy and PRISMA 2020 guidelines, four databases were investigated. Random-effects meta-analyses estimated pooled prevalences and small-study effects were assessed. RESULTS: Twenty-seven studies (n = 9618) were included. Conventional cystic artery and duct (CA and CD) anatomy was observed in 86.15% and 89.02% of cases, respectively. Among arterial variants, duplicate CA (7.18%) and caterpillar hump of the right hepatic artery (6.26%) were the most common "third elements" entering the hepatocystic triangle. CA positional deviations included courses posterior (14.95%), anterior (10.75%), and inferior (6.23%) to the CD. Aberrant right hepatic duct entering the hepatocystic triangle was recorded in 1.03%. CONCLUSIONS: Most CA and CD variations relevant to LC occur within the hepatocystic triangle, where they can interfere with identification of the vascular-biliary pedicle and increase the risk of vasculo-biliary injury. Integrating these findings into the cognitive framework of the Critical View of Safety (CVS) highlights the importance of anticipating "third elements" and heterotopic courses when dissecting.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.