Prevalence and Surgical Implications of Cystic Artery Variations in Calot's Triangle: A Prospective Observational...

Background  Variations in the cystic artery within Calot's triangle are clinically significant during laparoscopic cholecystectomy (LC), as unrecognized vascular anomalies may increase the risk of hemorrhage and bile duct injury. This study aimed to evaluate the prevalence and surgical implications of cystic artery variations in terms of origin, number, position, and location. Methods  This prospective observational study was conducted at Amar Hospital, Patiala, from 2023 to 2025 and included 100 patients undergoing LC. Intraoperative findings were recorded regarding cystic artery origin, number (single/double/absent), positional relationship to the cystic duct, location relative to Calot's triangle, and the presence of Moynihan's hump. Operative duration and blood loss were also documented. Data were analyzed using GraphPad Prism, and the Chi-square test was applied for categorical variables. Results  The mean age was 53.5 ± 13.81 years, with a female predominance (77%). The cystic artery originated from the right hepatic artery in 93% of cases, with variations arising from the gastroduodenal artery (5%), common hepatic artery (1%), and left hepatic artery (1%) (p < 0.001). A single cystic artery was observed in 96% of patients, while 4% had double arteries (p < 0.001). The artery was most commonly located superomedial to the cystic duct (93%) and within Calot's triangle (92%) (p < 0.001). Moynihan's hump was noted in 2% of cases. The mean operative time was 53.5 ± 13.81 minutes, and the mean blood loss was 19.9 ± 5.05 mL. Conclusion Although classical cystic artery anatomy predominates, significant variations exist. Careful identification of the cystic artery and adherence to the Critical View of Safety are essential to minimize intraoperative complications.