The effect of morphometric and anatomic relationship of gallbladder to the liver on standard laparoscopic cholecystectomies and proposal of a new anatomical classification

Abstract

OBJECTIVE: Anatomical variations of the extrahepatic biliary tree are frequently seen and may cause challenging conditions for surgeons. We aimed to investigate the morphological variations of the gall-bladder in patients who underwent cholecystectomy and their effects during and after the surgery, by using a new anatomical classification. PATIENTS AND METHODS: Dissection time, perioperative bleeding, perioperative/postoperative complication rates, the difference between preoperative/postoperative hematocrit and leukocyte levels of 164 symptomatic cholelithiasis patients who underwent laparoscopic cholecystectomy were evaluated. The patients' gallbladders were categorized in "seven" different types regarding their anatomical positions and morphometric relations with the liver's acute margin and fossa of the gallbladder. Relations between these gallbladders types and perioperative/postoperative parameters were also examined. RESULTS: The median time to complete the dissection of the gallbladder from the fossa was 375.5 seconds. The mean length of the fossa was 68.06 +/- 15.08 mm, the average size of the gallbladder was 92.10 +/- 18.79 mm. A positive correlation was found between dissection time and length of fossa vesica and also in the size of the gallbladder (p = 0.003, p = 0.034). Moreover, a positive correlation was found between the dissection time and the perioperative perforation risk of the gallbladder (p = 0.005). The most common type of gallbladder was type I and III (23.2%). The least common gallbladder type among the patients assessed as part of the study was type VI (6.7%). When the gallbladder types were compared, the perioperative perforation rate of the gallbladder wall was found to be significantly higher in morphological type V (p = 0.014). CONCLUSIONS: The perioperative perforation rate of the gallbladder wall was found significantly higher in morphological type V. To perform a safe cholecystectomy, surgeons should be aware of anatomical variations of the gallbladder and its relations with the liver parenchyma, which are important for surgical strategies.