Modified and dynamic intraoperativecholangiography during laparoscopic cholecystectomy in two patients with aberrant right posterior hepatic duct

Abstract

Aberrant right posterior hepatic duct (ARPHD) is one of the anatomical anomalies of the bile duct. It is a risk factor for bile duct injury during laparoscopic cholecystectomy (LC). ARPHD can be diagnosed before surgery by magnetic resonance cholangiopancreatography or drip infusion cholangiographic-computed tomography. However, it is not easy to identify ARPHD during LC. Classic intraoperative cholangiography (IOC) procedure that does not lead to bile duct injury avoidance needs to be modified. In modified IOC, cannulation is performed from the infundibulum or neck of the gallbladder. We reported a modified and dynamic IOC procedure that can identify ARPHD safely and precisely during LC. The modified IOC provided direct evidence of no injury to ARPHD in 2 cases.

Keywords

• Intraoperative cholangiography
• Laparoscopic cholecystectomy
• Aberrant right posterior hepatic duct
• Bile duct injury
• MRCP
• DIC-CT