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August 1957

Precautions and Errors in Surgery of the Gallbladder and Bile Ducts

AMA Arch Surg. 1957;75(2):307-312. doi:10.1001/archsurg.1957.01280140145028

Fig. 1.  —NORMAL ANATOMY: Anomalies are so common in the biliary tract that this sketch illustrates a composite of conditions most commonly observed.

Fig. 2.  —ANOMALY: Unusually mobile common duct covered with filmy adhesions (very common). DANGER: If the surgeon is careless and in a hurry, he may clamp the common duct and obstruct it with the ligature, as shown in the insert.

Fig. 3.  —ANOMALY: The right hepatic artery proceeds anteriorly from its position under the common duct, coursing forward adjacent to the cystic duct, and enters the liver a few millimeters anteriorly; thus it may resemble the cystic artery (10% to 15% of cases). DANGER: If the surgeon does not recognize this anomaly, he may ligate the right hepatic artery, thinking it is the cystic artery.

Fig. 4.  —ANOMALY: The right hepatic artery crosses anterior to the common duct (present in about 16% of cases). DANGER: If the

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