Biliary duct anomalies, which transform a routine gallstone operation into a potentially hazardous procedure, occur more frequently than surgeons realize, a Yale study has shown.
Among 1,000 consecutive patients undergoing surgery for cholelithiasis or its complications, 47.7% had duct structures which departed from the anatomical ideal.
"When the surgeon encounters such an anomaly unexpectedly he runs the risk of improperly identifying all structures and doing surgical damage to biliary drainage," Mark A. Hayes, MD, PhD, noted. "Common duct strictures, for instance, have a mortality of 50% or more."Dr. Hayes reported the study to the 46th annual Coller-Penberthy-Thirlby Medical Congress in Traverse City, Mich. He is professor of surgery in Yale's School of Medicine and attending surgeon at Yale-New Haven Hospital.
Most commonly encountered anomalies were abnormal length of the common hepatic duct, seen 232 times; and accessory ducts, observed in 157 patients. Together these accounted