Variations of Cystic Artery Supplying the Gallbladder and its Surgical Importance: A Cadaveric Study from Tamil Nadu, India

Abstract

Introduction: Symptomatic cholelithiasis is usually treated by cholecystectomy. Cystic Artery (CA) should be ligated prior to removal of gallbladder during cholecystectomy. CA arises from Right Hepatic Artery (RHA) posterolateral to common hepatic duct inside Calot’s triangle but variations of CA are very common. If surgeons fail to identify these variations during cholecystectomy, this artery is more prone to iatrogenic injury leading the profuse bleeding. Aim: To study the variations of CA in terms of its origin, number, length, course and its relation with the biliary ductal system and Calot’s triangle. Materials and Methods: The present cross-sectional study was conducted in the department of Anatomy, Government Tiruvannamalai Medical College, Tamil Nadu, India from August 2019 to July 2022. Forty adult cadaveric liver specimens with intact vasculature of gallbladder were dissected and the variations of CA were noted. Length of CA was measured by using Vernier caliper, and it’s descriptive statistics like range, mean, Standard Deviation (SD) were evaluated by using Microsoft excel 2019 software. Results: The CA arose from RHA in 33 (82.5%), from replaced RHA in 2 (5%), from Left Hepatic Artery (LHA) in 2 (5%), from Proper Hepatic Artery (PHA) in 2 (5%), and from Common Hepatic Artery (CHA) in 1 (2.5%) specimens. Its mean length ±SD was 2.6±0.35 cm. CA was single in 39 specimens (97.5%) (38 single CA inside Calot’s triangle, one single CA was outside of Calot’s triangle). Double cystic arteries were seen in only one specimen (2.5%) and forming compound type of relation with Calot’s triangle (one CA was outside of Calot’s triangle and the other one was inside of that triangle) in it. CA was superomedial to Cystic Duct (CD) in 34 (85%) specimens. This artery was passing anterior and posterior to common hepatic duct in 6 (15%) and 2 (5%) specimens, respectively. Conclusion: The overall prevalence of variations in different parameters of CA in the present study was found to be high as 35%.