Study of Anatomical Variations of Extra Hepatic Biliary System Found during Cholecystectomy

Background: Extra hepatic biliary system anatomy is of great importance for the surgeons since extra hepatic biliary system is one of the common sites of anatomical variations and it is most common sites for surgical dissection during cholecystectomy. Objective was to identify the complications occurring during and after cholecystectomy in patients with anatomical variations. Aim of study was to identify the most common anatomical variations of extra hepatic biliary system found during cholecystectomy. Methodology: This study was a prospective observational study carried out from January 2019 to December 2019 in Dr. B.R.A.M Hospital Raipur C.G. The study carried out in 60 patients diagnosed as cholelithiasis and under elective open, Lap, Lap to open cholecystectomy. Results: In present study, Out of 60 patients of cholelithiasis, 34 (56.66%) patients were females and 26 (43.33%) were males with female to male ratio is 1.5:1. The mean age of patients was 42.5 years and median age was 41.5years.Most of the patients presented with upper abdominal pain in the form of right hypochondrium pain (73.33%), pain in right hypochondrium with pain in epigastrium (20%) and epigastrium pain (6.66%). Multiple stones were present in 78.33% and 21.66% had single stone. In all operated patients, normal anatomy was found in 49 patients (81.60%) and anatomical variations of EHBS was found in 11 patients (18.33%) in which cystic duct variations (8.33%) was most common variations in the study followed by gall bladder variations (6.67%). No variations of right and left hepatic artery and hepatic duct encountered during surgery. Intra operatively, bleeding occurred in only 2 cases. All the patients were followed up for post operative complications for 7 days in which only in 3 cases, wound infection was found. Conclusion: Variations of anatomy of EHBS was found to be 18%.The most common variations is short cystic duct followed by intra hepatic gall bladder. So every surgeon should look for these variations during laparoscopic and open cholecystectomy in order to prevent inadvertent ductal clipping, ductal injuries and bleeding problems. Awareness to these variations will decrease morbidity, conversion and re-exploration in these patients.