Anatomical Variations of the Cystic Duct in Turkish Population and their Association with Biliary Track Stone

Objective: To evaluate the anatomy and various anatomical variations of the cystic duct and their association with the stones in the biliary tract in the Turkish population. Study Design: Observational study. Place and Duration of Study: Sivas Cumhuriyet University Hospital between November 2017 and August 2019. Methodology: Patients who had undergone MRCP procedures at the study centre were assessed retrospectively. MRCP images were used to evaluate the variations of the cystic duct. Association with the stones in the biliary tract was noted with p<0.05 as significant. Results: Three thousand MRCPs were evaluated. Among the 930 patients included in the study, 408 were males (43.9%), 61.9 +/- 17 years, while 522 were females (56.1 %), 57.1 +/- 19.2 years. The most common variation was lateral insertion in 372 patients (40%), medial insertion in 226 patients (24.3%), and high insertion in 137 patients (14.7%). Lateral, medial, high insertions (all p <0.001), parallel course of the cystic duct (p <0.001), low medial (p=0.024), and posterior insertion (p=0.003) were significantly associated with the calculi in the biliary tract. The highest coexistence frequency was at anterior, posterior, and low medial insertion variation groups, at 25%, 23.8%, and 25%, respectively. Conclusion: Preoperative information of anatomical variations of the cystic duct is not only important for operative planning; but some variations are significantly associated with the cholelithiasis and/or choledocholithiasis.