Clinico-Anatomical Variations of Hepatobiliary Vasculature and Gallbladder Encountered during Laparoscopic Cholecystectomy

Abstract

Objective: To identify and document the clinico-anatomical variations of hepatobiliary vascular structures and gallbladder observed during laparoscopic cholecystectomy.
Methodology: This descriptive cross-sectional study was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, from January 2024 to June 2025. A total of 350 patients who underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis were included. Intraoperative findings were carefully recorded to identify variations in the cystic artery, cystic duct, hepatic arteries, and gallbladder morphology.
Results: Out of the 350 patients who underwent laparoscopic cholecystectomy, 221 (63.1%) were female and 129 (36.9%) were male, with a mean age of 42.6±11.3 years. Clinico-anatomical variations were observed in 112 patients (32%). Cystic artery variations were noted in 84 patients (24%). The most common variation was a short cystic artery arising from the right hepatic artery (n=47; 13.4%), followed by a double cystic artery (n=21; 6%). In 16 cases (4.6%), the cystic artery originated from the aberrant right hepatic artery. Cystic duct anomalies were observed in 28 patients (8%), including low insertion (n=12; 3.4%), medial insertion (n=9; 2.6%), and short cystic duct (n=7; 2%). Anomalies in gallbladder position or shape were observed in 18 patients (5.1%). These included intrahepatic gallbladder (n=7), Phrygian cap deformity (n=6), and left-sided gallbladder (n=5).
Conclusion: Clinico-anatomical variations in hepatobiliary vasculature and gallbladder are frequently encountered during laparoscopic cholecystectomy. A thorough understanding of these variants is crucial for minimizing surgical risks and improving patient outcomes.
Keywords: Anatomic Variation, Bile Ducts, Cholecystectomy, Extrahepatic, Gallbladder, Hepatic Artery, Laparoscopic, Vascular System Abnormalities.