The Porta hepatis is centrally located in the middle third of the visceral surface; it has an "L" shape rotated ninety degrees to the left; it presents a transverse part, another anterior part, and they form a 90-degree angle of anterior medial sinus; the hepatic portal vein is divided here into right (A12.3.12.002) and left (A12.3.12.005) branches; the hepatic artery proper is divided into right (A12.3.12.030) and left (A12.3.12.035) branches; the common hepatic duct
is formed by the union of the right hepatic (A05.8.01.062) and the left hepatic (A05.8.01.065); these branches form the first vascular division; then, on the edge of this parenchymal channel, these two "primary branches" emit seven terminal secondary branches, forming seven vascular pedicles for seven portal segments.
The left and right hepatic duct
openings and the existence of accessory hepatic duct
were determined according to intraoperative cholangiography.
During laparoscopic cholecystectomy, gallbladder could not be identified but right and left hepatic duct
, common bile duct was normal as shown in Figure which lead to a confusion whether the gallbladder is congenitally absent or is present intrahepatic.
Mirizzi's syndrome (MS) is an unusual complication of gallstone disease and occurs in approximately 1% of all patients with cholelithiasis. The syndrome was first described in 1948 and is characterized by impaction of stones in the cystic duct or neck of the gallbladder (GB), resulting in mechanical obstruction of the common hepatic duct
and frequent clinical presentation of intermittent or constant jaundice.
During the procedure, the left and right hepatic bile ducts were fused after forming a long segment, and the cystic duct was observed to be draining to the right hepatic duct
In case of failure; T-tube placement with choledochotomy was preferred in limited injuries in the lateral surface of the duct in the distal part of the main hepatic duct
(3) For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct
orifice on the hepatectomy cross-section, LCBDE, EST, or percutaneous transhepatic cholangioscopic lithotripsy could be used.
Villous adenoma of the common hepatic duct
: the importance of contrast-enhanced ultrasound and endoscopic retrograde cholangiopancreatography for relevant diagnosis.
This occurs earlier if the tumor is located in the common bile duct or common hepatic duct
. Constitutional symptoms and abdominal pain only occur in advanced disease.
The hepatic artery proper, common hepatic duct
and hepatic portal vein were blocked using three vascular clips for 60 min (Figure 1C) followed by 120-min reperfusion (Figure 1D).
Type 1: Normal anatomy; right hepatic duct
and left hepatic duct
(LHD) merge to form the common hepatic duct
Dissection and clearance were done to the anterior wall of CBD, cystic duct, and common hepatic duct