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Updated: Apr 15, 2026

Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Parallel Configuration of the Cystic and Common Hepatic Ducts: a Surgical Odyssey
Gerasimia D Kyrochristou1, Dimitrios Kyrochristos1, Michail Siokas1
1Department of Surgery, University Hospital of Ioannina, Ioannina, Greece.
Insights
Laparoscopic cholecystectomy carries risks due to biliary anatomy variations. This case demonstrates how recognizing rare ductal configurations and converting to open surgery prevented bile duct injury.
Area of Science:
- Surgical procedures
- Gastroenterology
- Anatomy
Background:
- Laparoscopic cholecystectomy is a common procedure with a risk of bile duct injury.
- Anatomical variations and misinterpretation are leading causes of complications.
Introduction:
Laparoscopic cholecystectomy is among the most frequently performed surgical procedures worldwide; however, it carries a persistent risk of iatrogenic bile duct injury, particularly in the presence of anatomical variations. Misinterpretation of biliary anatomy remains a leading cause of serious complications, underscoring the importance of recognizing rare variants and adopting safe surgical strategies.
Case Report:
We report the case of a 78-year-old patient undergoing elective laparoscopic cholecystectomy for recurrent cholecystitis and cholangitis. Given the history of repeated inflammatory episodes, dense adhesions and intraoperative technical difficulties were anticipated. Intraoperatively, dense adhesions and a contracted gallbladder were encountered. Indocyanine green fluorescence imaging revealed uncertain anatomical landmarks, demonstrating a rare parallel configuration of the cystic duct and common hepatic duct. Due to unsafe conditions, conversion to open surgery was performed, allowing safe ligation of the cystic duct. The postoperative course was uneventful.
Conclusion:
This case highlights the critical role of anatomical awareness, intraoperative vigilance and timely adoption of bailout strategies to ensure a safe cholecystectomy and prevent biliary injuries.
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