Anatomic variations of intrahepatic bile ducts in a European series and meta-analysis of the literature

J Gastrointest Surg. 2011 Apr;15(4):623-30. doi: 10.1007/s11605-011-1447-4. Epub 2011 Feb 12.


Background: Accurate knowledge of biliary anatomy and its variants is essential to ensure successful hepatic surgery; however, data from European countries are lacking.

Methods: Two hundred cholangiograms obtained from patients submitted to whole liver transplantation were reviewed; donors' characteristics were related to the prevalence of typical biliary anatomy and its variants. A comprehensive literature search was performed with MEDLINE and EMBASE from 1980 to 2010 to investigate whether geographical origin could be related to biliary abnormalities.

Results: Typical biliary anatomy was observed in 64.5% of cases, but female donors more frequently presented an anatomic variation; typical anatomy was present in 55.0% of females and in 74.0% of males (P = 0.005). Twenty-two reports were identified by the literature search with a total of 7,559 cases, including the present series; heterogeneity was low (Q = 14.60; I2 < 5.0%) after exclusion of three outlier reports. Prevalence of typical biliary anatomy was similar in Europeans and Americans (∼60%); a slightly higher prevalence was observed in Asiatics (∼65%).

Conclusions: Anatomic variants seem to be more frequent in females, probably as a consequence of different embryologic development. Available data suggest that typical biliary anatomy can be more frequent in Asiatics, but an accurate means of classification is essential to making comparison realistic.

Publication types

  • Meta-Analysis

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Asia
  • Bile Ducts, Intrahepatic / abnormalities
  • Bile Ducts, Intrahepatic / anatomy & histology*
  • Child
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • United States
  • Young Adult