Impact of anatomical variations of cystic duct on the surgical outcome of laparoscopic common bile duct exploration

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a standard surgical method for patients with common bile duct (CBD) stones, but the impact of cystic duct anatomical variations is not clear.
Methods: A retrospective cohort study was conducted to analyze the frequency of different anatomical variation of cystic duct and the impact on the surgical outcome.
Results: The total variations account for 28.9% of all cases. The most prevalent variation is that parallel with CBD and low insertion of cystic duct, that is about 8.9%. Transductal approach was more commonly used in the condition of anatomical variation, 92.3% vs 76.8%, p<0.05. More T-tube usage (30.8% vs 12.5%) and higher open surgery conversion rate (7.2% vs 1.6%) were showed in the abnormal anatomical group, but without significance.
Discussion: Assessment of cystic duct anatomical variations is essential before LCBDE. Transductal approach might be the more suitable during the surgical procedure.