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Basic laparoscopy: Cholecystectomy 03.5 Anatomy / Bile ducts

Normal

The right and left hepatic ducts join to form the common hepatic duct.

The common hepatic duct is joined by the cystic duct to become the common bile duct.

The common bile duct runs downwards and behind the duodenum.

The common bile duct opens into the duodenum as it joins with the pancreatic duct at the ampulla of Vater.

Distortion

Traction on the gallbladder often causes:

Tenting of the common bile duct.

Sideways shifting of the common bile duct, mimicking the cystic duct.

Variants of the Cystic Duct

NB The variants of the cystic duct are not usually visible until they are dissected out.

Great care is therefore needed when dissecting in this area

Cystic duct origin from the right hepatic duct.

High junction with the common bile duct.

Low junction with the common bile duct.

Wide cystic duct.

Short or zero cystic duct.

Cystic duct winding around the common bile duct.

Accessory cystic ducts from the gallbladder bed.

Non specific Structures adjoining the Cystic Duct

Peritoneum.

Strands of fat.

Strands of adventitia.

Strands of fibrous tissue.

Minor blood vessels.

Lymphatic vessels.

Nerve fibres.

Cystic lymph nodes.

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