Post written by Andrea Tringali, MD, PhD, from the Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, and the Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy.

Our study is focused on 32 patients who underwent endoscopic treatment of “aberrant” hepatic duct injuries following cholecystectomy. “Aberrant” hepatic ducts represent a common (12-24%) anatomical variation; the “aberrant” duct can be injured due to its proximity to the cystic duct. Misidentification of the “aberrant” hepatic duct can lead to its ligation, transection, or injury during dissection of Calot’s triangle. The subsequent fistula and/or stricture of the “aberrant” duct can be managed endoscopically, but the treatment is challenging. Our large series is an attempt to standardize the treatment of this difficult situation.

In our series of 32 consecutive cases, 91% of the patients were asymptomatic after removal of plastic stents during a long-term follow-up (mean 10 years). Patients with associated biliary leakage from the “aberrant” duct had fistula healing in 91% of cases (10/11) after plastic stent placement. According to our results, we learned that patients with a complete transection and ligation of the aberrant duct do not require specific treatment if asymptomatic.

Multisciplinary approaches and careful evaluation of the biliary anatomy (ERCP and MRCP) are essential to treat the challenging anatomy of “aberrant” hepatic ducts. Future multicenter data collection can confirm our results and add further information.

Figure 1. Cholangiogram showing an aberrant hepatic duct (arrow) that drains close to the cystic duct (arrowhead).

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