Vicente Mitidieri & Nicolás Ernesto Ottone

Summary

Variations in intrahepatic biliary ducts are frequent. Its knowledge is of great importance when facing certain procedures such as drainage or a simple cholecystectomy to avoid iatrogenic lesion or incomplete drainage of the biliary tract. Nevertheless, it is during surgery that the surgeon attempts to see it for the first time, and must deal with complex classifications in order to recognize the ducts. This paper aims to suggest an easy and quick way to interpret and simple classification. 100 cholangiograms were studied and 10 cadaveric specimens were analyzed to support radiologic findings. As a result, we propose the following classification: Right "typical" biliary duct, when all the bile produced in the right hemiliver is drained by a single duct, or "divided" when sectional ducts reach separately the main bile duct. The same applies to the left hepatic ducts, "typical" or "divided". When both paramedian sections are drained by the same duct, there is a "Central" hepatic duct The biliary confluence may be "typical", when both hepatic ducts are also typical, "triple confluence" when one or both hepatic duct are divided and reach the main bile duct in the same place, or "staggered (selved) confluence" (etagée) when one of the ducts is divided and reaches the main bile duct separately from the others. This name is even proper if a segmentary duct reaches the main bile duct. We think this classification is easy to use due to its simplicity, allowing the surgeon to quickly identify each biliary duct and get through the surgery safely.

KEY WORDS: Intrahepatic biliary ducts; Colangiography; Classification.

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