Anatomical Variations of the Cystic Duct and Their Association with Bile Duct Injury during Laparoscopic Cholecystectomy: A Prospective Imaging-Correlated Study

Abstract

Objective: To evaluate the anatomical variations of the cystic duct and to determine their association with bile duct injury during laparoscopic cholecystectomy using the preoperative imaging correlation.

Study Design and Setting: This prospective observational study was conducted in the Department of General Surgery and Radiology in collaboration with Anatomy Department at Services Hospital, Lahore from October 2024 to June 2025.

Methodology: A total of 200 patients diagnosed with symptomatic cholelithiasis and scheduled for laparoscopic cholecystectomy were included. Magnetic resonance cholangiopancreatography (preoperative) was done to identify the cystic duct anatomy. Observations during intra-operation were recorded, and pertinent to imageries. The variations of cystic ducts were categorized based on the site of insertion, length and course in addition to relative to the common bile duct (CBD). Cases of intraoperative complications and bile duct injury were provided. The SPSS version 26.0 was used to statistically analyze the data and the chi-square and logistic regression were used to do the association analysis.

Results: Out of 200 patients, normal cystic duct anatomy was observed in 128 (64%), while 72 (36%) exhibited anatomical variations. Its most common ones were low insertion (18%), medial insertion (8%), and short cystic duct (5%). Bile duct injury on the patients was present in 10 (5%). It was discovered that a significant increase in a better incidence of bile duct injury was significantly high in patients whose duct variations were cystic in nature (p < 0.001). The findings of the logistic regression revealed that a low insertion and parallel course were good predictors of bile duct injury (Odds Ratio: 4.2 and 3.8 respectively).

Conclusions: Cystic duct anatomical variations are highly common and significantly associated with an increased risk of bile duct injury during the time of laparoscopic cholecystectomy. Preoperative MRCP plays a vital role in identifying these variations and reducing surgical complications