IMPACT OF ANATOMICAL AND PHYSIOLOGICAL VARIATIONS IN THE CYSTIC ARTERY AND SURGICAL RISK IN LAPAROSCOPIC CHOLECYSTECTOMY: A CROSS-SECTIONAL STUDY

Background: Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure for gallbladder diseases. Despite being minimally invasive, LC carries a risk of complications, primarily due to anatomical and physiological variations in the hepatobiliary system, especially the cystic artery. An understanding of these variations is crucial to reduce intraoperative bleeding, bile duct injury, and conversion to open surgery. Objective: To assess the prevalence and types of anatomical and physiological variations in the cystic artery and their impact on surgical risk during laparoscopic cholecystectomy. Methodology: This cross-sectional study was conducted over a period of 12 months from January to December 2024 at a tertiary care teaching Hospital Lahore. A total of 150 patients undergoing elective laparoscopic cholecystectomy were included. Intraoperative findings regarding the anatomy of the cystic artery such as origin, course, number, and relation to the cystic duct were documented. Data on intraoperative complications, conversion rates, and operative time were also recorded. Descriptive statistics and chi-square tests were used for analysis. A p-value of <0.05 was considered statistically significant. Results: Anatomical variations of the cystic artery were observed in 38% of cases. The most common variation was a double cystic artery (16%), followed by low-lying artery (12%), and artery arising from the right hepatic artery with a tortuous course (10%). Intraoperative complications occurred in 22% of cases with variant anatomy, compared to 6% in those with typical anatomy (p = 0.01). Mean operative time was significantly longer in patients with anatomical variations (78 ± 15 min vs. 56 ± 10 min, p < 0.001). Conversion to open surgery was required in 4 cases (2.6%), all of which had complex arterial variations. Conclusion: Anatomical and physiological variations in the cystic artery are common and significantly increase the risk of intraoperative complications during laparoscopic cholecystectomy. Preoperative planning and meticulous dissection techniques are essential to minimize surgical risks. Awareness and anticipation of such variations can improve surgical outcomes and reduce the rate of complications and conversion to open procedures.