Findings and Proposal for Systematization of Surgically Important Variations of the Cystic Artery Based on an in vivo Study of 2000 Outpatient Laparoscopic Cholecystectomies
Noguera Miguel Angel; Romero Cesar Alejandro; Martinez Aldo Gustavo; Diaz San Roman Hugo; Rotger Mariano & Espeche Federico
This is an anatomical study with the special and small dissection of a laparoscopic cholecystectomy on the surgically important variations of the cystic artery. A prospective, 19-month study was conducted in 2000, including consecutive patients undergoing programmed laparoscopic cholecystectomy, without signs of acute inflammation, or alteration, that would prevent dissection and correct evaluation of the cystohepatic triangle. It was surgically dissected, identifying the main cystic artery and its possible collateral arteries. Those with a diameter greater than 1.5 mm being considered as clinically important, requiring haemostatic maneuver (clipping and / or electrocoagulation). The findings were recorded on a special form for the purposes of this study. The classic, single-artery arrangement in the middle of the cystohepatic triangle was found in 1831 cases. The variations found were 169 (8.45 %). In 97 cases there was double vascularization, with one artery in normal position and another outside the cystic duct. In 44 patients, a single artery that did not cross the cystic was observed. In 22 cases an artery outside the cystic but crossing it before the duct. In 6 cases a double artery, one in the cystohepatic triangle and another outside the triangle, did not cross the cystic or the bile duct. In one instance, a single major artery was seen emerging directly from the cystic plaque between segments four and five. These can be divided into single or double arteries, based exclusively on the need for hemostatic maneuver. Knowledge of anatomical variations of the cystic artery is important for the surgeon. The variation presents in 1 of 12 cases, and requires a special hemostatic maneuver in 1 of 20 cases
NOGUERA, M. A.; ROMERO, C. A.; MARTINEZ, A. G.; DIAZ, S. R. H.; ROTGER, M. & ESPECHE, F. Findings and Proposal for systematization of surgically important variations of the cystic artery based on an in vivo study of 2000 outpatient laparoscopic cholecystectomies. Int. J. Morphol., 38(1):30-34, 2020.