Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 307-317
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.307
Classification of anatomical morphology of cystic duct and its association with gallstone
Jia-Hai Zhu, Song-Ling Zhao, Qiang Kang, Ya Zhu, Li-Xin Liu, Hao Zou
Jia-Hai Zhu, Song-Ling Zhao, Qiang Kang, Ya Zhu, Li-Xin Liu, Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
Hao Zou, Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming 650106, Yunnan Province, China
Author contributions: Zhu JH, Kang Q, Zhu Y, Liu LX, Zhao SL and Zou H designed the research study; Zhu JH, Kang Q, Zhu Y, and Liu LX performed the research; Zhu JH, Zhao SL and Zou H analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Supported by The Yunnan Medical Discipline Leader Training Program, No. D-2019012.
Institutional review board statement: The Ethics Committee of the Second Affiliated Hospital of Kunming Medical University approved the study, No. FEY-BG-39-2.0.
Informed consent statement: According to our Clinical Research Ethics Review Application/Reporting Guidelines, we have submitted our application for a waiver of informed consent to the ethics committee and have received their approval.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Zou, PhD, Professor, Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, No. 374 Dianmian Avenue, Wu Hua District, Kunming 650106, Yunnan Province, China. haozoukm@163.com
Received: October 5, 2023
Peer-review started: October 5, 2023
First decision: December 8, 2023
Revised: December 20, 2023
Accepted: January 16, 2024
Article in press: January 16, 2024
Published online: February 27, 2024
Abstract
BACKGROUND

Gallstones are common lesions that often require surgical intervention. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Preoperatively, the anatomical morphology of the cystic duct (CD), needs to be accurately recognized, especially when anatomical variations occur in the CD, which is otherwise prone to bile duct injury. However, at present, there is no optimal classification system for CD morphology applicable in clinical practice, and the relationship between anatomical variations in CDs and gallstones remains to be explored.

AIM

To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones.

METHODS

A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis.

RESULTS

Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones.

CONCLUSION

The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.

Keywords: Cystic duct, Gallstone, Classification, Anatomy, Magnetic resonance cholangiopancreatography, Risk factor

Core Tip: We propose a novel classification system for the morphology of cystic duct (CD) based on magnetic resonance cholangiopancreatography to guide clinical practice. We also found that CD tortuosity is an independent risk factor for gallstones, which provides a theoretical basis for the construction of predictive models and prevention in high-risk patients.