Anatomía quirúrgica del conducto colédoco: revisión de la clasificación topográfica / Surgical anatomy of the bile duct: revision of its topographical classification

Introducción: Se han clasificado diversas porciones del conducto colédoco, desde su origen en la unión cistohepática, hasta la segunda porción del duodeno. No se puede lograr un consenso al momento de segmentarlo, debido a que algunos autores sostienen la existencia de 3 o 4 porciones. Objetivo: El objetivo fue establecer la prevalencia de cada una de las porciones del conducto colédoco, determinar sus características morfológicas y analizar su asociación quirúrgica. Material y método: Estudio analítico de corte transversal en el que se diseccionaron 40 vías biliares. Resultados: Se evidenció 85% de porción retroduodenal, 20% retropancreática, 80% intrapancreática y 45% intramural. No se evidenció la porción supraduodenal debido a las relaciones anatómicas regionales, al tabique cistohepático o a una unión cistohepática baja. La combinación secuencial más frecuente fue la retroduodenal e intrapancreática. El conducto colédoco tuvo una longitud de 66,19 mm y un diámetro de 6,31 mm. Conclusiones: La segmentación biliar establecida tendría implicancias tanto teóricas, al justificar las teorías etiopatogénicas vigentes de la pancreatitis biliar, como prácticas, redefiniendo la coledocotomía supraduodenal y los cuadros clínicos de ictericia obstructiva.

Introduction. Several portions of the bile duct have been classified from its origin in the cystohepatic junction to its outfall in the second portion of the duodenum. An agreement could not be reached among the authors at the time of segmenting it, since some of them claim that there are three or four portions. Objective. To establish the prevalence of each of the bile duct portions, determine its morphological characteristics and to analyze its surgical associations. Material and method. A cross-sectional study. 40 biliary tracks were dissected. Results: Retroduodenal portion 85%, retropancreatic 20%, intrapancreatic 80%, intramural 45%. The supraduodenal portion was not made evident because of the regional anatomic relations, the cystohepatic septum or a cystohepatic lower junction. The bile duct had an average lenght of 66.19 mm and a diameter of 6.31 mm. Conclusions: The biliary segmentation would have a theoretical explanation to justify the etiopathogenic theories of the biliary pancreatitis, and a practical implication by redefining the choledochotomy supraduodenal and clinical pictures of obstructive jaundice.

The pancreatic ductal system and biliaropancreatic union: a study of 50 cases

Since its discovery in the 17th century, the anatomy of the pancreatic ductal system and its variations has been studied by numerous authors around the world, and Argentina is not an exception. Nevertheless, most of these researches were carried out upon non representative or insufficient population samples in order to determine a reliable amount of evidence. Therefore, the purpose of this study was to detail the course and distribution of pancreatic ducts and their convergence with the bile duct in adult corpses in the Medicine Faculty of Buenos Aires University. This scientific research has been developed under a non-experimental cross section descriptive design. Gross macroscopic classic dissection was performed in (n=50) adult human cadaveric pancreas-duodenum with no criteria of exclusion. The dissections were made using microsurgical tools and optical magnification devices. The measurements were obtained by means of a vernier caliper and a protractor. In addition, a digital photo camera was used in order to achieve the necessary photographic documentation of the results. The variables under study were recorded for statistic analysis. The exocrine pancreas ducts and their union with the bile duct were dissected and exhibited in all anatomical pieces. The morphological patrons were established in terms of length and gauge of the principal and accessory ducts, number of tributaries, distribution and course within the gland. Finally, we registered the angle between principal pancreas duct and bile duct, and between principal and accessory pancreatic ducts. We evaluated the degree of duct suppression, and the features of the biliaropancreatic ampulla, and major and minor duodenal papillae. According to the results, there were patterns of distribution of pancreatic ducts and biliaropancreatic union that provide anatomical basis for an etiopathogenic analysis of acute biliary pancreatitis (AU)

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