Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review

Table 1 Intra-hepatic bile duct variants according to Huang’s classification[3]

Description	Taiwan[3], n = 958 (%)	Caribbean, n = 152 (%)
Type A1: The RHD and LHD join to form the CHD. The intra-hepatic RHD is formed by the union of RASD and RPSD. The LHD is formed by the union of LSSD and LISD	600 (62.6)	109 (71.7)
Type A2: A trifurcation is formed by the union of RASD, RPSD and LHD	182 (19)	29 (19.1)
Type A3: The RPSD or RASD drains directly into the LHD	105 (11)	7 (4.61)
Type A4: The RPSD drains directly into the CHD	56 (5.8)	6 (3.95)
Type A5: The RPSD drains into the cystic duct	15 (1.6)	0

RASD: Right anterior sectional duct; RPSD: Right posterior sectional duct; RHD: Right hepatic duct; LHD: Left hepatic duct; CHD: Common hepatic duct; LSSD: Left superior sectional duct; LISD: Left inferior sectional duct.

Table 2 Global prevalence of intra-hepatic bile duct variants

Ref.	Country	Classification	Study population	Huang classification of biliary variants
				A1 (%)	A2 (%)	A3 (%)	A4 (%)	A5 (%)	Other
Couinaud[5], 1957	France	Couinaud1	298	1732 (58)	332 (11.1)	532 (30.6)	172 (5.7)	0	22
Puente and Bannura[6], 1983	Chile	Descriptive1	3845	2217 (57.6)	426 (11.1)	498 (13.0)	249 (6.5)	NS	455
Huang et al[3], 1996	Taiwan	Huang	958	600 (62.6)	182 (19)	105 (11)	56 (5.8)	15 (1.6)	0
Yoshida et al[7], 1996	Japan	Yoshida1	1094	741 (67.7)	193 (17.7)	66 (6.0)	88 (8.0)	0	0
Cheng et al[8], 1997	Taiwan	Huang	958	624 (65.1)	NS	105 (11)	NS	0	200 (21)
Nakamura et al[9], 2002	Japan	Couinaud1	120	78 (65)	11 (9.2)	10 (8.3)	19 (15.8)	2 (1.7)	0
Kitagawa et al[10], 2003	Taiwan	Huang	180	113 (62.7)	36 (20.0)	26 (14.4)	5 (2.8)	0	0
Choi et al[11], 2003	South Korea2	Choi1	300	188 (63)	292 (10)	342 (11)	192 (6)	62 (2)	282
Ayuso et al[12], 2004	Spain	Couinaud1	25	102 (40)	12 (4)	22 (8)	102 (40)	22 (8)	0
Ohkubo et al[13], 2004	Japan	Ohkubo1	110	722 (65)	62 (5)	132 (12)	52 (4.6)	12 (0.9)	13
Düşünceli et al[14], 2004	Turkey	Descriptive1	475	3602 (75.8)	42 (0.8)	NS	272 (5.7)	0	84
Lee et al[15], 2004	United States	Couinaud1	108	782 (72.2)	62 (5.6)	42 (3.7)	32 (2.8)	12 (9.3)	16
Limanond et al[16], 2004	United States	Huang	27	19 (70.4)	5 (18.5)	2 (7.4)	1 (3.7)	0	0
Wang et al[17], 2005	United States	Yoshida1	62	352 (56.0)	72 (11)	112 (18)	82 (13)	0	1
Chen et al[18], 2005	United States	Couinaud1	56	332 (58.9)	72 (12.5)	102 (17.9)	52 (1.8)	0	1
MacDonald et al[19], 2005	United States	Choi1	39	242 (61.5)	32 (7.7)	72 (17.9)	12 (2.6)	0	4
Kim et al[20], 2005	Canada	Champetier1	30	172 (56.7)	12 (3.3)	92 (30)	22 (6.7)	12 (3.3)	0
Wietzke-Braun et al[21], 2006	Germany	Ohkubo1	18	22 (11)	22 (11)	42 (22)	12 (6)	0	9
Kitami et al[22], 2006	Japan	Ohkubo1	158	116 (73)	8 (5.1)	19 (12)	5 (3)	NS	10
Vidal et al[23], 2007	France	Descriptive1	45	36 (80)	2 (4.4)	1 (2.25)	3 (6.6)	0	3
Cho et al[24], 2007	Japan	Cho1	60	382 (63.3)	142 (23.3)	72 (12)	12 (2)	02	0
Sirvanci et al[25], 2007	Turkey	Modified Huang1	62	43 (69.3)	6 (9.7)	9	3	0	1
Song et al[26], 2007	South Korea	Modified Huang1	111	67 (60.4)	9 (8.1)	22 (19.8)	8 (7.2)	2 (1.8)	3
Karakas et al[27], 2008	Turkey	Karakas1	112	612 (55)	162 (14)	242 (21)	112 (10)	0	0
De Filippo et al[28], 2008	Italy	Descriptive1	350	2022 (57.7)	282 (7.9)	112 (3.1)	NS	NS	109
Kim et al[29], 2008	South Korea	Modified Yoshida1	33	25 (75.8)	1 (3)	3 (9.1)	0	1 (3)
Sharma et al[30], 2008	India	Couinaud1	253	134 (52.9)	29 (11.5)	46 (18.2)	18 (7.1)	1 (0.4)	25
Kashyap et al[31], 2008	United States	Couinaud1	36	22 (61.1)	4 (11.1)	4 (11.1)	3 (8.3)	1 (2.8)	2
Cucchetti et al[32], 2011	Italy	Choi1	200	129 (64.5)	28 (14)	24 (12)	16 (8)	NS	3
Lyu et al[33], 2012	Taiwan	Yoshida1	462	307 (65.8)	42 (9.1)	60 (13)	41 (8.9)	15 (3.2)	0
Tawab et al[34], 2012	Egypt	Huang1	106	672 (63.2)	112 (10.4)	182 (17)	82 (7.5)	2 (1.9)	0
Thungsuppawattanakit and Arjhansiri[35], 2012	Thailand	Couinaud1	163	106 (65)	28 (17.2)	15 (9.2)	9 (5.5)	0	5 (3.1)
Barsoum et al[36], 2013	Egypt	Hakki1	50	282 (56)	32 (6)	152 (30)	22 (4)	02	0
Mariolis-Sapsakos et al[37], 2012	Greece	Couinaud1	73	482 (65.7)	72 (9.59)	112 (15.1)	22 (2.74)	12 (1.37)	4 E
Uysal et al[38], 2014	Turkey	Choi1	1011	803 (79.4)	81 (8.01)	42 (4.15)	73 (7.23)	NS	12
Deka et al[39], 2014	North India	Choi1	299	173 (57.8)	242 (8)	522 (17.4)	202 (6.6)	72 (2.3)	23
Al-Jiffry[40], 2015	Saudi Arabia	Couinaud1	177	1042 (58.8)	192 (10.7)	72 (3.9)	122 (6.8)	22 (1.1)	332
Khanduja et al[41], 2016	North India	Huang	100	63 (63)	18 (18)	9 (9)	8 (8)	0	23
Nayman et al[42], 2016	Turkey	Yoshida1	2143	1329 (62)	202 (95)	245 (11)	149 (7)	1 (0.05)	9
Sarawagi et al[43], 2016	North India	Karakas1	224	124 (55.3)	26 (9.3)	62 (27.6)	9 (4)	2 (0.8)	0
Adwan et al[44], 2016	Jordan	Yoshida1	120	822 (68.4)	102 (8.3)	152 (12)	NS	NS
Taghavi et al[45], 2017	Iran	Huang	362	163 (45)	78 (21.5)	48 (13.3)	13 (3.6)	0	60 (16.6)
Mazroa et al[46], 2017	Egypt	Hakki1	50	242(48)	42(8)	152(30)	72(14)	02	0
Adatepe et al[47], 2016	Turkey	Choi1	1041	6162 (40.7)	1332 (12.8)	1262 (12.1)	522 (4.99)	02	114
Abdelkareem et al[48], 2019	Palestine	Modified Huang1	342	266 (77.8)	29 (8.5)	2 (0.6)	1 (0.3)	1 (0.3)	43
El Hariri et al[49], 2019	Egypt	Modified Huang1	120	79 (65.8)	14 (11.7)	16 (13.3)	9 (7.5)	2 (1.67)	0
Medişoğlu et al[50], 2020	Turkey	Huang	79	29 (36.7)	27 (34.2)	16 (20.3)	7 (8.9)	02	0
Global prevalence	Global	-	17045	10668/17045 (62.6)	1853/16087 (11.5)	1903/16570 (11.5)	1006/15617 (6.4)	66/11361 (0.58)
Present study	Caribbean	Huang	152	109 (71.7)	29 (19.1)	7 (4.61)	6 (3.95)	0	1
P value				0.0227	0.0069	0.0047	0.2466	1.0	-

¹Different classification used.

²Extrapolated from raw data and/or published images.

³Removed by authors from analysis due to poor visualization. NS: Not specified.