Anatomy of the gall bladder in Sri Lankan population : a warning to the laparoscopic surgeon.

Abstract

INTRODUCTION : Minimally invasive surgery has advanced rapidly to involve resection of almost all abdominal organs. Out of all these procedures, laparoscopic cholccystectomy has become the operation of choice for the removel of gall bladder and has stood the test of time. AIM : Since we started laparoscopic cholecystectomy procedure in our unit, this study was designed to document the possible variations that we may encounter in the Sri Lankan population. MATERIAL AND METHODS : Seventy five fresh non selected adult cadavers (within 24 hours of death) were dissected, Exclusion criteria were those with crush injuries to the liver and previous hcpato-biliary surgery. Findings were documented according to a standard proforma. FINDINGS : Normal anatomy was seen in 22 ( 29.3%) bodies. Documented abnormalities given in the text books were seen in 45 (60% ). Eight (10.6%) new abnormalities were detected in our study GB - 0, cystic duct - 5, cystic artery - 7). CONCLUSIONS : Altogether nearly seventy percent of the cadavers showed developmental anomalies. Therefore a thorough knowledge of all these anomalies is essential for the surgeon performing laparoscopic cholecystectomy to avoid iatrogenic injury.