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
ARTICLE HIGHLIGHTS
Research background

At present, there is no optimal classification of the morphology of the cystic duct (CD) applicable to clinical practice, and the relationship between anatomical variation of the CD and gallstone remains to be explored.

Research motivation

Classification of anatomical morphology of CD can be applied to clinical practice to reduce the occurrence of bile duct injury, and we also found that CD tortuosity is an independent risk factor for gallstone. In the future, we will construct predictive models based on the risk factors for gallstone identified in our study to provide individualized follow-up strategies for high-risk groups.

Research objectives

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

Research methods

This was a case-control study. We retrospectively collected data on patients underwent magnetic resonance cholangiopancreatography with (without) gallstones at the Second Affiliated Hospital of Kunming Medical University, Yunnan, China. 300 patients with (without) gallstones identified by abdominal ultrasound and magnetic resonance cholangiopancreatography were enrolled from October 2021 to January 2022. They were divided into two groups: The gallstone group and the non-gallstone group. Data such as sex, age and body mass index were collected.

Research results

Of the 300 patients enrolled in this study, 200 (66.7%) of them had gallstones. The mean age was 48.10 ± 13.30 years, of which 142 (47.3%) were male and 158 (52.7%) were female. 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the magnetic resonance cholangiopancreatography, 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 showed differences between the gallstone and non-gallstone groups in relation to sex, BMI, cholesterol, triglyceride, morphology of CD, site of the CD insertion into the extrahepatic bile duct, length of CD, the angle between the common hepatic duct and CD. In the multivariate analysis, female, BMI (≥ 24 kg/m2), and morphology of CD [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 gallstone.

Research conclusions

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

Research perspectives

Basic and clinical research of diseases in hepatopancreatobiliary surgery.