Prevalence of Variations of Patterns of Cystic Artery and its’ Clinical Significance among Human Population: Systematic review and meta-analysis

Abstract

Abstract Background The cystic artery, typically branching off from the right hepatic artery is a crucial anatomical structure commonly identified and managed during traditional or laparoscopic cholecystectomy. There is a risk of bleeding from the cystic artery during surgery, as well as potential harm to nearby ducts in hepato-biliary procedures. Understanding the potential variations in the origin of the cystic artery and Calot's triangle, as well as its relationship with surrounding structures, can help prevent unintentional damage during hepato-biliary surgeries. This study aims to evaluate the overall prevalence of variations in the cystic artery and its clinical significance in the global human population Methods This review is carried out in accordance with the protocol of Systematic reviews and Meta-Analysis (PRISMA) guidelines. Condition, context and population framework approach was used. Articles were searched from PubMed, Scopus, EMBASE, CINHAL, Web of Science and others. Data was clearly summarised and presented in tabular and narrative forms. In addition, meta–analyses were performed on methodologically comparable studies. Results Sixteen studies with a total of 1510 human cadaveric specimens were included for this systematic review and meta-analysis. The following anatomic variations were assessed: Variation of roots of origin, variation on numbers of vessels, variation of course, variation of branching pattern of cystic artery. The pooled global prevalence of the variation of roots of origin of cystic artery among human populations in these reviewed studies was 10.39 (95% CI: 7.09–13.69) and among the variant roots with their pooled prevalence include hepatic artery proper 2.99 (95% CI: 7.09–13.69), common hepatic artery 2.14 (1.22, 3.06), aberrant hepatic artery 3.22 (2.00, 4.45), gastro-duodenal artery 0.90 (0.16, 1.64) and superior mesenteric artery 4.14 (1.81, 6.48). The pooled prevalence of variation in numbers of vessels of cystic arteries was found to be 6.26 (95% CI: 3.56–8.97). The pooled prevalence of variation of course of cystic arteries which was identified to be outside Calot’s triangle was 31.42 (17.27, 45.57). The pooled prevalence of variation of branching pattern of cystic arteries was found to be 3.95 (0.60, 7.30). Our finding reported the pooled prevalence of cystic arteries continued as superficial branch is found to be 9.85 (2.29, 17.41) and those continued as a deep branch to be 2.6 (0.164, 5.3). Conclusions and Recommendation: This systematic review and meta-analysis is the first estimate of pooled prevalence of variation of patterns of cystic artery. Accordingly, the pooled global level prevalence of variant patterns of cystic artery is found to be considerable amount. A better understanding of anatomy of biliary apparatus and cystic artery can help decrease the surgical mortality in cholecystectomy.