ANATOMICAL VARIATIONS OF THE GALLBLADDER AND CYSTIC ARTERY: A RETROSPECTIVE REVIEW OF LAPAROSCOPIC CHOLECYSTECTOMY REPORTS

Abstract

Anatomical variations of the gallbladder and cystic artery are of significant clinical relevance during laparoscopic cholecystectomy, as unrecognized anomalies increase the risk of intraoperative complications, including bile duct injury and hemorrhage. Despite advances in minimally invasive surgery, variability in hepatobiliary anatomy continues to pose challenges for surgeons, emphasizing the importance of detailed preoperative and intraoperative recognition.

Aims & Objective: This study aimed to retrospectively analyze the prevalence and patterns of anatomical variations of the gallbladder and cystic artery encountered during laparoscopic cholecystectomy, thereby providing evidence-based insight to improve surgical safety and outcomes. Methodology: A retrospective review of operative records from January 2023 to December 2024 was conducted, encompassing 1,423 patients who underwent laparoscopic cholecystectomy at a public sector tertiary care hospital of Lahore, Pakistan. Patient demographic data, gallbladder anatomical variations, and cystic artery patterns were systematically extracted and analyzed. Statistical analysis included descriptive frequencies and chi-square testing to evaluate associations between anatomical variations and demographic characteristics.

Results & Findings: Among 1,423 patients, gallbladder anomalies were observed in 8.7%, including Phrygian cap deformity (3.2%), septate gallbladder (2.1%), and ectopic positioning (1.5%). Cystic artery variations were identified in 14.9%, with aberrant course posterior to the common hepatic duct being the most frequent (6.4%). Age stratification revealed that variations were significantly more common in patients >40 years (p < 0.05). No statistically significant association was found between sex and anatomical variations.

Conclusion: Anatomical variations of the gallbladder and cystic artery remain clinically relevant findings that directly impact the complexity and safety of laparoscopic cholecystectomy. Recognition of these variations, combined with meticulous dissection and application of the critical view of safety principle, is paramount to reducing surgical complications. This study underscores the necessity for surgical vigilance and recommends the integration of intraoperative imaging or preoperative diagnostic modalities in high-risk cases.