Ryan Pereira1,2, Talbir Singh1, John Avramovic1, Sam Baker1, Guy D Eslick2, Michael R Cox2,3. 1. North Queensland Minimally Invasive Surgery, Mater Medical Centre, Sydney, New South Wales, Australia. 2. The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia. 3. Department of Surgery, Nepean Hospital, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: A left-sided gallbladder (LSGB) is a rare anatomical anomaly that is often not discovered until surgery. Two cases of LSGB managed with laparoscopic cholecystectomy (LC) stimulated this systematic review. The aims of this study were in LSGB to define the rate of pre-operative detection, variations in biliary anatomy, laparoscopic techniques employed and outcomes of surgery for symptomatic gallstones. METHODS: A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses principles. RESULTS: Fifty-three studies with 112 patients of which 90 (80.4%) had symptomatic gallstones. Pre-operative imaging was performed in 108 patients (96.4%) with an LSGB reported on imaging in 32 (29.6%) patients. The remainder of LSGB were discovered at surgery. Ultrasound detected an LSGB in three (2.7%) patients. Five variants of cystic union with the common hepatic duct (CHD) were identified. The most common (67.8%) was union on the right side of the CHD after a hairpin bend anterior to the CHD. A cholecystectomy for gallstone disease was performed in 90 patients, 23.3% open and 76.7% LC. Common variations in LC technique were different port site placement and techniques related to the falciform ligament to improve exposure. Common bile duct injury occurred in four (4.4%) patients. CONCLUSION: LSGB is a rare anatomical variation that in patients with symptomatic gallstones is usually discovered at surgery. Cholecystectomy is associated with a higher incidence of common bile duct injury.
BACKGROUND: A left-sided gallbladder (LSGB) is a rare anatomical anomaly that is often not discovered until surgery. Two cases of LSGB managed with laparoscopic cholecystectomy (LC) stimulated this systematic review. The aims of this study were in LSGB to define the rate of pre-operative detection, variations in biliary anatomy, laparoscopic techniques employed and outcomes of surgery for symptomatic gallstones. METHODS: A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses principles. RESULTS: Fifty-three studies with 112 patients of which 90 (80.4%) had symptomatic gallstones. Pre-operative imaging was performed in 108 patients (96.4%) with an LSGB reported on imaging in 32 (29.6%) patients. The remainder of LSGB were discovered at surgery. Ultrasound detected an LSGB in three (2.7%) patients. Five variants of cystic union with the common hepatic duct (CHD) were identified. The most common (67.8%) was union on the right side of the CHD after a hairpin bend anterior to the CHD. A cholecystectomy for gallstone disease was performed in 90 patients, 23.3% open and 76.7% LC. Common variations in LC technique were different port site placement and techniques related to the falciform ligament to improve exposure. Common bile duct injury occurred in four (4.4%) patients. CONCLUSION: LSGB is a rare anatomical variation that in patients with symptomatic gallstones is usually discovered at surgery. Cholecystectomy is associated with a higher incidence of common bile duct injury.
Authors: Thaís Regina Moreira Printes; Írian Evelyn Cordeiro Rabelo; Júlia F Cauduro; Estevan C Lopez; Christhian F V Dos Santos; Tigran Francis Chehuan Melo; Hafiza Gonçalves Alexandrino Regino; Adriano Augusto Pereira Machado Journal: AME Case Rep Date: 2020-10-30