Aberrant right hepatic duct presenting as empyema of the gall bladder

Clinical implications of aberrant anatomy of the common hepatic duct in liver surgery: a systematic review and meta-analysis

INTRODUCTION

Knowledge of anatomical variants that affect the hepatic duct (HD) are of particular clinical relevance during hepatobiliary surgical procedures. More specifically, the aberrant anatomy of the common HD is the most common anatomical variation affecting the biliary tree. Below, we describe different classifications of anatomical variants that affect this canal. According to Huang's classification, variations are determined depending on the insertion of the right posterior hepatic duct (RPHD).

MATERIALS AND METHODS

Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases were investigated until January 2024. The methodological quality was assessed with an anatomical studies assurance tool (AQUA). Pooled prevalence was estimated using a random effects model. For the subgroup analysis, Student's T-test was used.

RESULTS

The prevalence rate of aberrant hepatic duct (AHD) was 15% (confidence interval [CI] of 7-22%). The first subgroup had cadavers and images. For the cadavers, the prevalence was 15.83% (CI: 11.22-18.3%), while the images had a prevalence of 22.06% (CI: 18.12-25.33%). This subgroup analysis showed no statistically significant difference between these groups (p = 0.127). The second subgroup comprised the continents where the included studies were from. In this subgroup, no statistically significant differences were found (p = 0.613). Finally, regarding the right or left laterality of the HD variant, there were no statistically significant differences (p = 0.089).

CONCLUSION

A AHD corresponds to a finding that can occur in a significant percentage of our society, which could be an accidental discovery during surgeries or present asymptomatically throughout life and be a cadaveric discovery later. We believe it is important for surgeons to have prior knowledge of the possible variants of HD to prevent possible complications during and after surgery.

Interposition of gallbladder - a rare extrahepatic biliary anomaly

An unusual anamoly of the extrahepatic bitiary system is reported in which the common hepatic duct was found to enter the gallbladder, whereas the cystic duct drained the entire biliarysystem into the duodenum. Excision of the gallbladder and cystic duct and a roux-en-Y hepaticojejunostomy was performed. Identification and treatment options of this rare anomaly are briefly discussed.