Cystic Lymph Node: Caution of Safety in Calot's Triangle Dissection

Different landmarks are described in laparoscopic cholecystectomy for correct identification and orientation of structures to make the procedure as safe as possible. Among these one of the important landmarks is cystic lymphnode which always lies lateral to the biliary tree and forms the medial end point of dissection. This study was done to determine frequency of identification of cystic lymph node in our population. This retrospective descriptive study was conducted on 217 patients who underwent laparoscopic cholecystectomy for cholelithiasis from January 2012 to December 2013 over a period of two years in Jamal Noor Hospital and Hamdard University Hospital Karachi. All procedures were recorded and reviewed. Frequency of identification of cystic lymph node was documented in different levels of difficulty and whether it was possible to keep the dissection lateral to lymph node. Difficulty was assessed per-operatively by Cuschieri's scale. During dissection cystic lymph node was identified in 170(78.34%) cases. In majority of patients i.e. 165(97.05%), it was related to cystic artery. In 78(45.88%) patient dissection was possible lateral to lymph node. Cystic lymph node can be identified in majority of patients undergoing laparoscopic cholecystectomy and this identification helps in safe dissection of Calot's triangle. Efforts should be made to remain lateral to lymph node to avoid injuries to hepatic pedicle.