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Quadrate lobe: a reliable landmark for bile duct anatomy during laparoscopic cholecystectomy
Author(s) -
Rajkomar Kheman,
Bowman Matthew,
Rodgers Michael,
Koea Jonathan B.
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13509
Subject(s) - quadrate bone , medicine , anatomy , cystic duct , bile duct , common bile duct , cholecystectomy , intrahepatic bile ducts , surgery
Background This investigation was undertaken to determine whether the shape of the inferior surface quadrate lobe (segment IV ) can assist in defining a safe starting point for dissection during laparoscopic cholecystectomy. Methods Patients undergoing laparoscopic cholecystectomy were prospectively audited. Intraoperative cholangiograms and photographs of the quadrate lobe were reviewed measuring the angle between the cystic duct and common bile duct and its relationship to quadrate shape. Results The results of 56 patients were included. The shape of the inferior surface of the quadrate lobe was rectangular in 35, pyramidal in 13 and square in eight patients. The median cystic/bile duct angle was 43°, 37° and 26° for square, rectangular and pyramidal quadrate shapes, respectively. The angle for pyramidal‐shaped lobes was narrower than that for rectangular or square lobes ( P < 0.05). Regression analysis showed an inverse relationship between the shape ratio and the cystic/bile duct angle ( P = 0.015). Conclusion This investigation confirms a relationship between the shape of the inferior surface of the quadrate lobe and the cystic/bile duct angle and suggests that the anatomy of the inferior surface of the quadrate lobe can be used to define an optimal starting point for dissection of the biliary cystic triangle.