Anatomical Variations of Cystic Artery During Laparoscopic Cholecystectomy; An Audit Of 400 Cases of Laparoscopic Surgery for Gall Bladder Pathologies at a Tertiary Care Unit

Abstract

Objective: To assess the frequency of anatomical variations of cystic artery in patients undergoing laparoscopic cholecystectomy. Study design: Prospective observational study. Settings: Department of Surgery, Al-Bukyriah General Hospital, Al-Bukayriah, Alqaseem Kingdom to Saudi Arabia. Duration: 01 June 2012 to 07 December 2016. Introduction: Traditionally, open cholecystectomy can manage overwhelming hemorrhage efficiently but being the gold standard and carries rewards of abbreviated incisions, laparoscopic cholecystectomy has to ensure absolute hemostasis and for it, understanding of blood vessels anatomy and their variations is crucial. Methodology: 400 patients with symptomatic gall bladder pathologies. The patients were evaluated clinically and radiologically (ultrasound) for the gall bladder pathologies and underwent laparoscopic cholecystectomy. During procedure, the origin, number, length and course of cystic artery was noted. Results: There were 62 (15.5%) men and 338 (84.5%) women with a mean age of 38.98+7.68 years (Range: 27-65 years). There were 133 (33.25%) patients with acute cholecystitis, 211 (52.75%) with chronic cholecystitis and 56 (14%) patients with acute on chronic chlecystitis. The most common anatomical findings noted in cystic artery during laparoscopic were that it was single (92.25%), originating from right hepatic artery (90.25%), crossing cystic duct anteriorly (72.75%) and of 2-3cm in length (68%). Conclusion: anatomical variations in cystic artery are not uncommon and this awareness will augment the harmless laparoscopic cholecystectomy.