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Surgical Considerations of the Cystic Duct and Heister Valves
Lucas N Pina1,2, Franca Samoilovich1, Sebastián Urrutia1
1Department of Anatomy, University of Buenos Aires (UBA), Buenos Aires, Argentina.
Insights
Heister valves in the cystic duct (CD) are common but do not follow a predictable pattern. Their variable anatomy may impact transcystic procedures, but incision planning should not rely on their distribution.
Area of Science:
- Anatomy
- Surgical Anatomy
Background:
- Heister valves are mucosal folds within the cystic duct (CD).
- Their potential to obstruct transcystic exploration is recognized.
- Previous suggestions of a systematic, spiral distribution lack conclusive evidence.
Purpose of the Study:
- To characterize the anatomy of the cystic duct and Heister valves.
- To investigate the distribution patterns of Heister valves in adult human cadavers.
Main Methods:
- A descriptive cross-sectional study was conducted.
- Analysis of 46 extrahepatic biliary tracts from adult human cadavers.
Main Results:
- The cystic duct averaged 25.37 mm in length and 4.53 mm in diameter.
- Heister valves were found in 32 (69.6%) of the CDs studied.
- The most frequent distribution pattern was nonreticular, specifically the B1 subtype, with an oblique disposition.
Conclusions:
- Heister valves are common anatomical features that may impede transcystic exploration.
- The morphology and distribution of Heister valves do not exhibit a consistent, systematic pattern.
- Cysticotomy incision planning should not be based on the presumed distribution of Heister valves.
Abstract:
Objectives Heister valves are mucosal folds located on the endoluminal surface of the cystic duct (CD) and were first described by Lorenz Heister in 1732. Their presence could represent an obstacle that impedes transcystic exploration. It has been suggested that the distribution of Heister valves follows a steady rhythmic pattern in a spiral disposition; however, there is no conclusive data to support this claim. The aim of this study was to describe the main characteristics of the CD and Heister valves in adult human cadavers. Methods A descriptive cross-sectional study was performed on 46 extrahepatic biliary tracts. Results The CD has an average length of 25.37 mm and diameter of 4.53 mm. The most frequent level of junction was the middle union. Heister valves were present on 32 CDs; in most cases, they were distributed uniformly on the duct and presented an oblique disposition. A nonreticular pattern was the most frequent reticular pattern. The most frequent type of the nonreticular type was the B1 subtype. The most frequent type of distribution was the nonreticular type, particularly the B1 type. Conclusions The cystic fold could hinder transcystic exploration. The cysticotomy incision should not be determined by the distribution of the fold on the CD. The morphology of the Heister valves does not show evidence of a steady systematic pattern.
