Which aery should be saved while operating common bile duct stricture?
Causes of stricture of bile duct - MCC -iatrogenic Vascular injury Choledochotomy incision: longitudinal incision because transverse incision may injure collateral blood supply. Vascular supply or biliary tract Supra duodenal & infra hilar bile ducts are predominantly supplied by two axial vessels that run in a 3 and 9-0'clock These vessels are derived from the superior pancreaticoduodenal, right hepatic, cystic gastroduodenal, and retro duodenal aeries It has been estimated that only 2% of the aerial supply to this poion of the bile duct is segmental and arises directly off of the proper hepatic aery. Approximately 60% of the blood supply to the supra duodenal bile duct originates inferiorly from the pancreaticoduodenal and retro duodenal aeries. Whereas 38% of the blood supply originates superiorly from the right hepatic aery and cystic dust aery The blood supply to the common bile duct and common hepatic duct is illustrate: right hepatic aery (a); 9:00 aery (b); retroduodenal aery (c); left hepatic aery (d); proper hepatic aery (e); 3:00 aery (f); common hepatic aery (g); gastroduodenal aery (h).
Common hepatic aery
Right hepatic aery
Left hepatic aery
Celiac trunk
JIPMER 2018