Căile biliare extrahepatice

Abstract

Background: It is well-known that the extrahepatic bile ducts diseases has a permanent growing rate in the overall structure of human morbidity and, therefore, their treatment takes a special place in modern surgical science. Current surgical practice has revealed a vast individual anatomical variability of the bile ducts. It is considered that 10-20% of the Earth’s population have different variants of the extrahepatic bile ducts. Taking into consideration a considerable number of the blood vessels network individual peculiarities of the region, as well, variants of, their overall proportion reaches to 40-50%. An increasing number of publications in scientific journals, textbooks and atlases are dedicated to the anatomical variants of the extrahepatic bile ducts. Conclusions: Theoretically, it may be found that every second person is a carrier of an individual variant of the location of the arterial and bile systems from hilum and hepatic pedicle. Moreover, their relationship with the level of hepatic peduncle frequently changes on the background of inflammation of the gall bladder or of the adjacent formations. Each encounter with the situation of an atypical location of anatomical structures of the hepato-duodenal ligament put in front of the surgery a dilemma and very often fosters the emergence of serious disabling complications, the frequency of which has no tendency to decrease. Thus, the extra-hepatic biliary ducts modify their form, dimensions, itinerary depending on the age, normal or pathological condition, affection of the organs in the neighbourhood, etc. Together with the variations of the fusion angle of the common hepatic duct with the cystic one, their topographic co-relations also vary very much, therefore the hepatic duct is oftener located medially to the cystic duct, even if other variants are not excluded either: lateral or posterior side of the common hepatic duct in regard to the cystic one, their repeated crossing, etc. The systematized information in question may condition or even determine, to a certain extent, the strategic aspects in the terms of diagnosis, treatment and prognosis.