A Type V Aberrant Right Hepatic Duct Branching from the Cystic Duct: The Paramount Importance of Intraoperative Cholangiography in Supplementing the Critical View of Safety Technique in Laparoscopic Cholecystectomy

Hema M. Narlapati, Simon H. Telian, MD, Gregory S. Peirce, MD, Adam J. Kaplan, MD, MS

Edward Via College of Osteopathic Medicine, Spartanburg, SC, AL. (Dr. Narlapati)
Womack Army Medical Center, Ft Bragg, NC. (Dr. Telian)
Uniformed Services University of the Health Sciences, Bethesda, MD. (Dr. Kaplan)

ABSTRACT
In this report, we present a 38-year-old female with acute cholecystitis, in which an aberrant right hepatic duct draining directly into the cystic duct was revealed by intraoperative cholangiography during a laparoscopic cholecystectomy. This anomaly was classified as the class V variant using the Hisatsugu classification schema, which has an incidence of 1.02%. The use of Strasberg’s critical view of safety has become ubiquitous in laparoscopic cholecystectomy. Intraoperative cholangiography provides and additional layer of safety, and should be considered as a routine practice, particularly when imaging to delineate biliary anatomic aberrancies has not been performed prior to surgery.

Key Words: Aberrant right hepatic duct, Cholangiography, Critical field of view, Laparoscopic cholecystectomy.

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