Anatomical Variations and Congenital Anomalies of the Gallbladder Observed during Laparoscopic Cholecystectomy

SHORT COMMUNICATION
Abdelrhman Alyan, Hamza Mohamed, Hassan Ali Musa, Tagreed Ahmed, Danish Anwer, Khalid Musa Fadlelmula Awadlseid

 
For citation: Alyan A, Mohamed H, Musa HA, Ahmed T, Answer D, Awadlseid KMF. Anatomical Variations and Congenital Anomalies of the Gallbladder Observed during Laparoscopic Cholecystectomy. International Journal of Biomedicine. 2024;14(4):719-722. doi:10.21103/Article14(4)_ShC
 
Originally published December 5, 2024
 

Abstract: 

Background: Understanding the basics of embryologic development and the structure of the gallbladder can help identify and detect various abnormalities. This study aims to identify anatomical variations and congenital anomalies of the gallbladder in Sudanese patients observed during laparoscopic cholecystectomy. 
Methods and Results: A retrospective study included 345 patients diagnosed with cholelithiasis who underwent laparoscopic cholecystectomy. The study patients’ ages ranged from 14 to 71, with a mean age of 45.59±13.29 years. Of 345 cases of cholelithiasis, 83.2% were females, and 16.8% were males, with a female-to-male ratio of 4.95:1. Preoperative ultrasound examination revealed chronic cholecystitis in 99.7% of patients. Among the operated patients, the majority (99.13%) underwent laparoscopic cholecystectomy and 0.87% open cholecystectomy. A normal anatomy of the biliary system was found in 82.9% of all patients who underwent laparoscopic cholecystectomy. Among 59 patients with anomalies of the biliary system, gallbladder anomalies were detected in 19(32.2%) cases and included buried gallbladder (11.9%), floating gallbladder (1.7%), double gallbladder (3.4%), bilobed gallbladder (8.5%), and diverticulum of the gallbladder (6.8%).
Conclusion: During laparoscopic cholecystectomy, surgeons must identify anomalies to prevent unintended intraoperative injury and bleeding, thereby improving postoperative outcomes.

Keywords: 
gallbladder • biliary system • cholelithiasis • laparoscopic cholecystectomy
References: 
  1. Ahmed S, Tuttle-Newhall JE. Liver anatomy and anatomic variants. Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease. 2014:3-19.
  2. Vlek SL, van Dam DA, Rubinstein SM, de Lange-de Klerk ESM, Schoonmade LJ, Tuynman JB, Meijerink WJHJ, Ankersmit M. Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surg Endosc. 2017 Jul;31(7):2731-2742. doi: 10.1007/s00464-016-5318-7. Epub 2016 Nov 14. PMID: 27844236; PMCID: PMC5487840.
  3. Cohen JT, Charpentier KP, Beard RE. An Update on Iatrogenic Biliary Injuries: Identification, Classification, and Management. Surg Clin North Am. 2019 Apr;99(2):283-299. doi: 10.1016/j.suc.2018.11.006. Epub 2019 Feb 10. PMID: 30846035.
  4. Wang X, Yu WL, Fu XH, Zhu B, Zhao T, Zhang YJ. Early Versus Delayed Surgical Repair and Referral for Patients With Bile Duct Injury: A Systematic Review and Meta-analysis. Ann Surg. 2020 Mar;271(3):449-459. doi: 10.1097/SLA.0000000000003448. PMID: 32106173.
  5. Shim H, Aikins A, Hyun H, Choi HJ, Kim CK. Negative Impact of Indwelling Biliary Stent on Gallbladder Visualization on Cholescintigraphy. Clin Nucl Med. 2015 Nov;40(11):856-8. doi: 10.1097/RLU.0000000000000931. PMID: 26252334.
  6. Aljiffry M, Abbas M, Wazzan MAM, Abduljabbar AH, Aloufi S, Aljahdli E. Biliary anatomy and pancreatic duct variations: A cross-sectional study. Saudi J Gastroenterol. 2020 May 26;26(4):188–93. doi: 10.4103/sjg.SJG_573_19. Epub ahead of print. PMID: 32461381; PMCID: PMC7580731.
  7. Simmons CL, Harper LK, Patel MC, Katabathina VS, Southard RN, Goncalves L, Tran E, Biyyam DR. Biliary Disorders, Anomalies, and Malignancies in Children. Radiographics. 2024 Mar;44(3):e230109. doi: 10.1148/rg.230109. PMID: 38358937.
  8. Kumar A, Mohanty NR, Mohanty M, Dash S. Comparison of MRCP and ERCP in the evaluation of common bile duct and pancreatic duct pathologies. Front Med Technol. 2023 Jul 12;5:946555. doi: 10.3389/fmedt.2023.946555. PMID: 37521722; PMCID: PMC10374843.
  9. Langenbuch AK, McKernan CB. Gallbladder and biliary tract. Rush University Medical Center Review of Surgery. 2017:380.
  10. Christou N, Roux-David A, Naumann DN, Bouvier S, Rivaille T, Derbal S, Taibi A, Fabre A, Fredon F, Durand-Fontanier S, Valleix D, Mathonnet M. Bile Duct Injury During Cholecystectomy: Necessity to Learn How to Do and Interpret Intraoperative Cholangiography. Front Med (Lausanne). 2021 Feb 17;8:637987. doi: 10.3389/fmed.2021.637987. PMID: 33681264; PMCID: PMC7925835.
  11. Talpur KA, Laghari AA, Yousfani SA, Malik AM, Memon AI, Khan SA. Anatomical variations and congenital anomalies of extra hepatic biliary system encountered during laparoscopic cholecystectomy. J Pak Med Assoc. 2010 Feb;60(2):89-93. PMID: 20209691.
  12. Balla A, Quaresima S, Corona M, Lucatelli P, Fiocca F, Rossi M, Bezzi M, Catalano C, Salvatori FM, Fingerhut A, Paganini AM. ATOM Classification of Bile Duct Injuries During Laparoscopic Cholecystectomy: Analysis of a Single Institution Experience. J Laparoendosc Adv Surg Tech A. 2019 Feb;29(2):206-212. doi: 10.1089/lap.2018.0413. Epub 2018 Sep 25. PMID: 30256167.
  13. Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006 May-Jun;26(3):715-31. doi: 10.1148/rg.263055164. PMID: 16702450.
  14. Abdalla AE, Ali TO, Rezigalla AA, Abdalla MI, Mohamed MZ. Variations of the gallbladder in Sudanese subjects with literature review. Indian J Med Sci. 2012 Mar-Apr;66(3-4):62-5. PMID: 23603622.
  15. Katti SCP, Dwivedi S, Nagula BP. Study on variations of the vascular and extrahepatic biliary system in laparoscopic cholecystectomy and its associated outcomes. European Journal of Cardiovascular Medicine. 2023;13(3);1403-1407.
  16. El Moufid H. Gallbladder Agenesis in Adults Presenting with Chronic Biliary Pain. EC Gastroenterology and Digestive System. 2022;9:39-42.
  17. Gupta R, Kumar A, Hariprasad CP, Kumar M. Anatomical variations of cystic artery, cystic duct, and gall bladder and their associated intraoperative and postoperative complications: an observational study. Ann Med Surg (Lond). 2023 Jul 10;85(8):3880-3886. doi: 10.1097/MS9.0000000000001079. PMID: 37554913; PMCID: PMC10406088.

Download Article
Received October 16, 2024.
Accepted November 26, 2024.
©2024 International Medical Research and Development Corporation.