The laparoscopic solution in a case of congenital cystic duct anomaly: a case report and review of the literature

In 1654, Francis Glisson first described the anatomy of the cystic duct. In 1921, a case of missing cystic duct was first described by Walton [1]. Such a rare finding is almost always detected accidentally in abdominal surgery or in the autopsy. Congenital anatomical variations of the Cystic Duct (CD) occur in 18-23% of cases, but the inherited lack of CD is a much lesser anomaly with severe surgical complications in non-diagnostic cases-preoperatively or intraoperatively, which raises the issue of its clinical importance and appropriate surgical approach. The period of the patient`s recurrent complaints varies between two and 25 years until the time of surgery. The average cystic duct length is 30 mm (ranging from 4 mm to 65 mm) [2,3] as cystic duct diameter varies from 3 mm to 9 mm. Anatomic variations of cystic ducts are frequently encountered during imaging-USD, MRCP, ERCP. Failure to recognize some of the clinically important variants leads to a complication during surgical, endoscopic, or percutaneous intervention procedures [4]. The normal and pathological anatomy of the cystic duct is comprehensively described [4]. Some rare cystic duct anomalies such as its absence with the gallbladder emptying directly into the common bile duct are mentioned, too [5,6]. Absent or short cystic duct (length<5mm) is one of the very rare anatomic variations described in the literature [7]. The literature review shows that open cholecystectomy is the method of choice when missing CD is detected preoperatively or conversion from a laparoscopic operation in case of accidental detection of an abnormality [1,4-6]. In this case report, we present a patient with a laparoscopic operation and intraoperatively found a lack of CD, recognized and differentiated as an abnormality in which a laparoscopic cholecystectomy was performed with the introduction of a linear stapler placed parallel to the Common Hepatic Duct (CHD) and Common Bile Duct (CBD). Postoperative recovery was uneventful.

Abstract

Isolated congenital cystic duct absence is a very rare pathology of the biliary tract. A comprehensive review of the patients identified in the literature available is presented. Traditionally, open surgery such as retrograde or anterograde cholecystectomy is performed. A 53-year old patient in whom during laparoscopic cholecystectomy a missing cystic duct has been diagnosed is reported to illustrate the effectiveness of a new laparoscopic approach. This approach consists of the laparoscopic resection of the gallbladder with a linear stapler, leaving a small segment of it as a simple choledochoplasty. After a detailed literature review inaccessible publications, we have not found another report presenting such a laparoscopic approach, and we also note the extremely small number of cases of missing cystic duct that has been reported so far. We believe that this laparoscopic method can validate and prove its effectiveness and be useful in the field of laparoscopic surgery.