Trigonum Cystohepaticum: Critical Anatomical Area for Surgical Safety

DOI : http://dx.doi.org/10.4067/S0717-95022014000300019
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Rubén Daniel Algieri; María Soledad Ferrante; Juan Sebastián Ugartemendía; María de las Mercedes Bernadou; Lucas Pina & Agustín Álvarez Escalante

Summary

Knowing the anatomy of the bile duct and its anatomical variations becomes essential to safely perform any surgery. Gallbladder resection requires careful attention: knowing the region's anatomy by heart and taking into account the possibility of anatomical variations. Misunderstanding the anatomy is not only a failure in technical ability but also a cause of injury to the bile duct during a cholescystectomy. The objectives of this study were, to distinguish the boundaries and content of the trigonum cystohepaticum. Furthermore, to design the areas of Safety and Critical Vision as a safety measure for the patient undergoing surgery. Analysis of 458 surgical reports on cholecystectomies performed from January 2010 to October 2012 by the Hospital Aeronáutico's General Surgery Department, and dissection of 12 adult cadavers preserved in a 10% formalin solution at the IIIrd Chair of Anatomy, School of Medicine, University of Buenos Aires. From 458 cholecystectomies, surgical reports were classified as mentioning: Calot triangle, 247 (53.93%); cystohepatic triangle, 59 (12.88%); critical vision area, 152 (33.18%). None of them mentioned Buddé triangle or trigonum cystohepaticum. Twelve adult cadavers were dissected in which we identified the cystic artery: originating from right hepatic artery, 9 (75%); originating from left hepatic artery, 2 (16.66%); and originating from hepatic artery, 1 (8.34%). Trigonum cystohepaticum is observed in 7 cadavers (58.35%). Knowing the anatomy of the bile duct and its anatomical variations becomes essential to safely perform any surgery. The triangle described by Calot is the lower half of the triangle described by Buddé. The lateral portion (Safety Triangle) is the area of critical vision to be dissected due to the lower probability of injuring noble structures.

KEY WORDS: Trigonum cystohepaticum; Cystohepatic triangle; Calot triangle; Buddé triangle.

How to cite this article

ALGIERI, R. D.; FERRANTE, M. S; UGARTEMENDÍA, J. S.; BERNADOU, M. M.; PINA, L. & ÁLVAREZ, E. A. Trigonum cystohepaticum: critical anatomical area for surgical safety. Int. J. Morphol., 32(3):860-865, 2014.