A Systematic Review of Gallbladder Anomalies

Abstract

Background:

Gallbladder anomalies are rare congenital defects resulting from developmental disruptions. These variations in shape, position, or number are often incidental findings but can present with symptomatic gallstone disease. Undiagnosed anomalies may lead to surgical complications like bile duct injuries and incomplete cholecystectomy. Despite their clinical significance, standardized guidelines remain limited. This systematic review consolidates current knowledge on classification, diagnosis, and management.

Methods:

Given the rarity of gallbladder anomalies, single case reports were excluded. The database search yielded 3,789 articles, with 1,975 excluded based on language, relevance, and duplication. After screening, 164 articles underwent full-text review, and seven case series met inclusion criteria.

Results:

The selected studies covered embryological development, classification, diagnostic imaging, and surgical approaches. Common imaging methods included ultrasound, magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) scans.

Discussion:

Gallbladder anomalies pose diagnostic and surgical challenges, increasing the risk of bile duct injury. Greater awareness and standardized guidelines are needed. This review highlights early recognition and tailored intervention to optimize outcomes, emphasizing the need for standardized protocols.

INTRODUCTION

The gallbladder develops from the hepatic diverticulum, which begins forming during the fourth week of embryonic development. Specifically, the hepatic diverticulum splits into a cranial bud (pars hepatica) and caudal bud (pars cystica), with the latter further dividing into inferior and superior buds. It is the superior bud that ultimately develops into the gallbladder. Initially, the gallbladder is hollow, but it becomes filled with endodermal cells before later undergoing recanalization.^1,2

During early development, the gallbladder is attached to the ventral surface of the duodenal precursor, and later rotates to be on the dorsal surface due to differential growth. It eventually migrates to its final position on the anterior inferior surface of the liver between segments IV and V. Before reaching its final location, the gallbladder is transiently intrahepatic.³ Deviations at any stage of this complex developmental process are hypothesized to result in various gallbladder anomalies.

Some common gallbladder anomalies include agenesis (complete absence of the gallbladder), duplication (presence of one or more extra gallbladders), and ectopic gallbladder (anomalous positioning, such as within the liver). These anomalies can impact gallbladder function and its integration with the biliary system.⁴ Additionally, certain developmental variations involve both the gallbladder and bile ducts, such as the cholecystohepatic duct, aberrant right hepatic duct (ARHD), and subvesical duct. These anomalies result from disruptions in the embryological development of the hepatobiliary system, resulting in atypical anatomical connections or accessory structures.

Understanding these anomalies is critical for minimizing surgical complications, as they can alter the anatomy and function of the hepatobiliary system. This review article provides a comprehensive analysis of gallbladder anomalies, focusing on their embryological origins, clinical significance, diagnostic modalities, and surgical implications.

METHODS

Literature Search Strategy

We conducted a systematic review of peer-reviewed English-language articles on gallbladder anomalies. Our protocol adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) extension statement.⁵ We comprehensively searched electronic databases, including PubMed/MEDLINE, Scopus, and ScienceDirect, covering publications from 2005 to 2025. Keywords used in the search included: “gallbladder agenesis,” “gallbladder duplication,” “bilobed gallbladder,” “gallbladder positional anomalies,” “left-sided gallbladder,” “ectopic gallbladder,” “wandering gallbladder,” “floating gallbladder,” “cholecystohepatic duct,” “hepaticocholecystic duct,” “aberrant right hepatic duct,” and “subvesical duct.” Titles and abstracts were screened by the authors (R.R. and A.H.) to determine eligibility for inclusion in the review.

Inclusion and Exclusion Criteria

Given the rarity of gallbladder anomalies, much of the available literature consists of single case reports and small case series. To improve the reliability and generalizability of our findings, single case reports were excluded, as they lack the statistical power and broader applicability. Instead, we prioritized case series to provide a more comprehensive understanding of the patterns, diagnosis, and management of gallbladder anomalies.

The initial database search yielded 3,789 articles. A total of 1,975 articles were excluded as they were duplicates, not written in English, published before 2005, or lacked relevance based on title, abstract, study type, or full-text availability. After manual screening by the first author (R.R.), 1,650 articles were excluded for failing to meet the inclusion criteria or being single case reports. A total of 164 articles were selected for full-text evaluation. Following this review, seven articles met all criteria and were deemed relevant for inclusion in the study Figure 1. These articles are summarized in Table 1.^6–12

Figure 1.

Flow diagram of study identification, screening, eligibility assessment, and inclusion in the systemic review.

Table 1.

Case Series and Systematic Reviews on Gallbladder Anomalies

Authors	Type of Paper	Year	Patients with Gallbladder Anomalies	Gallbladder Anomaly Type
Mohammed and Arif6	Case series	2019	6	Gallbladder position anomaly
Mendoza et al7	Case series	2018	2	Left-sided gallbladder
Darnis et al8	Systematic review	2018	181	Multiple gallbladders
Pereira et al9	Systematic review	2019	112	Left-sided gallbladder
Carannante et al10	Systematic review	2023	231	Subvesical bile duct
Schnelldorfer et al11	Systematic review	2012	156	Subvesical bile duct
Valenzuela et al12	Systematic review	2024	2916	Aberrant right hepatic duct

RESULTS

Types of Gallbladder Anomalies

Differences in gallbladder number

Gallbladder agenesis.

Gallbladder agenesis is a rare congenital condition characterized by the complete absence of the gallbladder and cystic duct, resulting from a failure in embryological development. It occurs in approximately 0.01–0.065% of the population and is more frequently identified in females than males.¹³ This condition arises when the cystic bud fails to develop and may present either in isolation or in association with other congenital biliary anomalies.

Gallbladder agenesis is often asymptomatic and discovered incidentally, but in symptomatic cases, it commonly mimics gallstone disease. Patients may present with nonspecific symptoms such as right upper quadrant pain, nausea, vomiting, and dyspepsia, which can lead to misdiagnosis of cholecystitis or gallstones. These clinical similarities complicate diagnosis and management.¹⁴

According to Malde, the recommended diagnostic workup for suspected gallbladder agenesis includes magnetic resonance cholangiopancreatography (MRCP), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), or endoscopic ultrasound (EUS). These imaging modalities should be considered when the gallbladder is not visualized or appears shrunken on abdominal ultrasound (US).¹⁵ Among these, MRCP is the preferred method, as it provides definitive confirmation and helps prevent unnecessary surgical interventions. Additionally, hepatobiliary iminodiacetic acid (HIDA) scans, when obtained, can be misleading. The absence of a visualized cystic duct is often interpreted as cystic duct occlusion, indicative of cholecystitis.

In many cases, gallbladder agenesis remains unsuspected, as imaging may suggest a contracted gallbladder, leading to surgical interventions without further imaging. Intraoperatively, the absence of a gallbladder often results in extensive dissection and exploration, increasing the risk of iatrogenic injury to the biliary tree or surrounding vasculature. A high index of suspicion and appropriate imaging are critical to avoid unnecessary surgical complications and improve outcomes.^16–19

Duplicate gallbladder.

Duplicate gallbladders are characterized by the presence of two or more gallbladders with ductal drainage patterns. This rare anomaly has an incidence of approximately 1 in 4,000.²⁰ The most common type of gallbladder duplication, known as an accessory gallbladder (type 2 multiple gallbladder), involves a normal gallbladder with typical ductal drainage and an additional gallbladder that drains separately via its own cystic duct into the common bile duct (CBD). In contrast, the less common variant (type 1 or split primordial gallbladders) occurs when the two cystic ducts converge before joining the CBD.²¹

From an embryologic perspective, type 1 anomalies result from a late division of the pars cystica, whereas type 2 anomalies arise when the pars cystica divides before differentiation, leading to complete duplication of the gallbladder and cystic duct.²¹ Rare cases of triple or even quadruple gallbladders have been reported but are exceptionally uncommon.

Although duplicate gallbladders do not inherently increase the risk of gallbladder disease, affected patients often present with typical symptoms, such as biliary colic or gallstone-related complications.²² Identifying duplicate gallbladders can be challenging, as they may be mistaken for folded gallbladder bodies on US or CT imaging. Magnetic resonance imaging (MRI) and MRCP are the most sensitive diagnostic tools, outperforming ERCP, which was once considered the gold standard. Surgical management involves removing all gallbladders, even if only one is affected by gallstone disease. This can prevent the high risk of recurrent disease in the remaining gallbladder(s).^8,23,24

Differences in gallbladder position

Floating gallbladder.

The term floating gallbladder describes a gallbladder that is freely mobile within the peritoneal cavity. This condition is believed to affect approximately 4% of the population.²⁵ Mobility arises due to an absent or abnormally long and redundant gallbladder mesentery, preventing the gallbladder from being affixed to the liver surface as it typically would be. This anomaly is thought to result from disrupted migration of the gallbladder to its normal position on the right lobe of the liver during development.

The absence of mesenteric attachments can lead to complications such as herniation of the gallbladder through the foramen of Winslow or gallbladder torsion.²⁶ While a floating gallbladder is often asymptomatic, it can cause colicky symptoms due to intermittent herniation or torsion, which may progress to ischemia or perforation in severe cases. Symptomatic presentation almost always includes right upper quadrant pain.

Preoperative imaging rarely reveals the lack of peritoneal attachments, and the diagnosis is most often made intraoperatively. During cholecystectomy, it is crucial for surgeons to reposition the gallbladder into its proper anatomical location before dividing the cystic duct and artery. This ensures clear identification of the biliary anatomy and reduces the risk of complications.²⁷

Left-sided gallbladder.

A left-sided gallbladder is located on the inferior surface of the left lobe of the liver, to the left of the falciform ligament. This rare anomaly has an estimated incidence of 0.1%–1.2%.²⁸ Two primary hypotheses explain its embryologic origin. The first suggests abnormal migration of the gallbladder from the right to the left side of the liver’s inferior surface during development. The second posits the formation of an accessory gallbladder off the left hepatic duct, with subsequent atrophy of the normal right-sided gallbladder, leaving only the left-sided gallbladder.

In cases of abnormal migration, the cystic duct typically attaches to the right side of the CBD and wraps around it, whereas in the accessory gallbladder scenario, the cystic duct originates from the left side.²⁹ Additionally, the vascular anatomy in the porta hepatis, including hepatic artery and portal vein, may vary.

A left-sided gallbladder can often be identified preoperatively using cross-sectional imaging, although it may be difficult to appreciate on US. Contrast-enhanced imaging and MRCP are helpful for delineating ductal and vascular anatomy prior to surgical interventions. If the anomaly is identified intraoperatively and the ductal anatomy is unclear, performing an intraoperative cholangiogram (IOC) is recommended to minimize the risk of bile duct injury.³⁰ Additionally, during cholecystectomy, surgeons should remain vigilant for accompanying anatomic variants such as right anterior portal vein originating from the left portal vein or early CBD bifurcation.³¹

Intrahepatic gallbladder.

While partially intrahepatic gallbladders are relatively common, completely intrahepatic gallbladders are rare, with an incidence of 0.1%–0.7%.³² This anomaly occurs when the gallbladder’s migration from its original intrahepatic position to its normal extrahepatic position arrested during development.

Patients with an intrahepatic gallbladder often present with symptoms of cholelithiasis, as the intrahepatic position increases the likelihood of gallstone formation. US is usually sufficient to identify the intrahepatic position; however, cross-sectional imaging is recommended to confirm the diagnosis and distinguish the gallbladder from hepatic cysts. These imaging modalities also help delineate ductal and vascular anatomy.

In symptomatic cases, cholecystectomy is indicated and often requires partial hepatectomy to access and remove the gallbladder. To avoid bile duct injuries, surgeons should identify the cystic duct should be identified at the cystic plate and follow it to the gallbladder. In cases of significant bleeding or difficulty identifying ductal anatomy, there should be a low threshold to convert to open cholecystectomy.³³

Concurrent anomalies of the gallbladder and bile ducts

Concurrent anomalies involving the gallbladder and bile ducts are rare but clinically significant due to their potential impact on diagnosis and surgical management. Below are key examples of such anomalies:

Cholecystohepatic duct (hepaticocholecystic duct).

The cholecystohepatic duct, also known as the hepaticocholecystic duct, is an anatomical variant in which an anomalous bile duct directly connects the liver parenchyma to the gallbladder. This anomaly is reported in approximately 0.7–1.2% of cases, although its true incidence may be much lower.³⁴ In this variant, bile flows from the liver into the gallbladder and then drains into the CBD via the cystic duct, bypassing the formation of a common hepatic duct (CHD).

While the cholecystohepatic duct itself is asymptomatic, it significantly increases the risk of choledocholithiasis due to the direct communication between the gallbladder and CBD. Diagnostic imaging modalities such as MRCP, ERCP, percutaneous transhepatic cholangiography (PTC), or IOC are essential for identifying this anomaly. In a recent case, a patient presented with choledocholithiasis and obstructive jaundice. Preoperative MRCP, ERCP, and intraoperative pictures are shown in Figure 2. We identified this anomaly intraoperatively due to meticulous dissection and was managed with cholecystectomy with hepaticojejunostomy.

Figure 2.

Preoperative ERCP, MRCP and intraoperative pictures demonstrating cholecystohepatic duct. (A) ERCP visualizing cholecystohepatic duct with CHD draining into the gallbladder which subsequently drains directly into CBD via a large cystic duct. (B) MRCP showing dilated bile ducts draining into the gallbladder through the cholecystohepatic duct. (C) Intraoperative photo demonstrating the cholecystohepatic duct with gallbladder in between the CHD and CBD. One white vessel loop encircles the CHD, which drains into the gallbladder, while another white vessel loop identifies the cystic duct. Last picture depicts the transected stump of CHD, which drained directly into the gallbladder, prior to reconstruction. Abbreviations: ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography; CBD, common bile duct; CHD, common hepatic duct.

Surgeons must be aware of this rare anomaly before performing cholecystectomy, as inadvertent injury to the cholecystohepatic duct can lead to significant complications, including bile duct injury and bile leaks. Accurate preoperative identification is ideal; however, if the anomaly is discovered intraoperatively, careful dissection and the judicious use of IOC are critical to minimize complications. Furthermore, in cases of uncertain anatomy, consultation with hepatobiliary surgeons or aborting the operation is strongly advised.³⁵

ARHD.

An ARHD is a rare biliary tree anomaly with an incidence of 4.6%–8.4%.³⁵ Originating from the posterior segment of the right hepatic lobe, it may drain into the CHD, CBD, left hepatic duct, cystic duct or even the gallbladder. This variation poses challenges during cholecystectomy or liver resection due to its atypical location, increasing the risk of bile duct injury. Preoperative MRCP is instrumental in diagnosing ARHD and visualizing the draining pattern. IOC can further confirm the anatomy, guiding decisions to preserve or ligate the ARHD based on its functional drainage area, although accurate estimation of the corresponding drainage region can be challenging intraoperatively. Also, ducts smaller than 1 mm are usually ligated, while those larger than 2 mm or draining multiple liver segments require reconstruction. Inappropriate removal of the ARHD can result in complications such as recurrent cholangitis, intrahepatic lithiasis, liver atrophy, or possible cholangiocarcinoma.³⁶

Subvesical bile duct (SVBD).

The SVBD is an aberrant duct located within the gallbladder fossa and hilar plate. Its prevalence ranges widely from 1% to 50% due to variations in diagnostic methods.³⁷ SVBDs often drain into the right hepatic duct, CBD, or less commonly the left hepatic duct. While SVBDs are small ducts, measuring 1–2 mm in diameter and typically do not drain significant portions of liver parenchyma., they are clinically significant due to their proximity to the gallbladder bed and potential for injury during cholecystectomy, which can result in postoperative bile leaks. Proper identification and preservation, or appropriate control with a clip or tie, are essential to prevent these complications.¹¹ Preoperatively, they may be identified by MRI and MRCP, although it can be challenging due to small duct size. Intraoperatively, direct visualization or IOC is commonly used to assess this bile duct anatomy. If bile leak occurs postoperatively, ERCP is the preferred modality for diagnosis and treatment.³⁸

Clinical Presentation and Symptoms of Gallbladder Anomalies

Although rare, awareness of gallbladder anomalies in adults is critical, as they can influence the clinical presentation of common gallbladder diseases and increase the risk of complications during surgical interventions such as cholecystectomy.³⁹ For clinicians and radiologists, early identification of these anomalies is essential to prevent unnecessary exploratory operations. In cases where surgical intervention is required, preoperative recognition of these anomalies allows for better operative planning and helps surgeons anticipate challenges posed by unexpected or unusual anatomy, ultimately improving surgical safety and patient outcomes.^40,41

While gallbladder anomalies are often asymptomatic, they can sometimes mimic common biliary conditions, presenting with nonspecific symptoms such as right upper quadrant pain, nausea, vomiting, and dyspepsia. These symptoms are frequently mistaken for gallstones or cholecystitis, leading to misdiagnoses when the underlying cause is an anatomical anomaly. Rarely, complications such as biliary colic, obstructive jaundice, or acute cholecystitis can occur due to abnormal gallbladder positioning or structure, requiring prompt surgical intervention. Thorough diagnostic evaluations are important to promptly identify congenital anomalies, ensuring appropriate treatment and minimizing unnecessary procedures and potential complications.

Diagnosis and Imaging Modalities

Most gallbladder anomalies are diagnosed incidentally during cholecystectomy or hepatobiliary operations. While preoperative diagnosis is ideal for aiding surgical planning and ensuring safe operations, it can be challenging in patients presenting with typical biliary colic or nonspecific symptoms. Contrast-enhanced MRI with MRCP is considered the gold standard for diagnosing gallbladder anomalies. It is particularly useful in preoperative evaluations for hepatobiliary surgery, as it provides high-resolution imaging of the gallbladder, biliary ducts, and associated vasculature.³

Eovist contrast, also known as gadoxetate disodium, is a gadolinium-based agent used specifically in MRI of the liver. Eovist is both extracellular and hepatocyte-specific, allowing partial uptake by functioning liver cells and excretion into the bile.⁴² This dual property enhances the visualization of biliary structures, including small or aberrant bile ducts, strictures, and leaks. Eovist-enhanced MRI enables the identification of subtle anomalies that might not be evident on standard imaging techniques. It is a noninvasive alternative to procedures like ERCP, offering the added benefit of assessing liver function indirectly through its hepatocyte uptake.⁴³

ERCP is another imaging modality useful for visualizing the biliary ducts, particularly in cases of choledocholithiasis, biliary strictures, or bile leaks. However, ERCP is invasive and carries risks such as pancreatitis or duodenal perforation; hence, it is typically reserved for therapeutic interventions or when other noninvasive imaging proves insufficient.

HIDA scanning is primarily used to assess gallbladder function and biliary drainage. It is particularly useful in diagnosing acute cholecystitis, biliary dyskinesia, or sphincter of Oddi dysfunction. HIDA scans can differentiate between obstructive and nonobstructive conditions, providing additional insights into gallbladder and bile duct function.⁴⁴

Rare anomalies such as gallbladder agenesis and cholecystohepatic duct are prone to “zebra retreat bias,” wherein radiologists and surgeons may hesitate to diagnose uncommon conditions even when imaging findings suggest them. This diagnostic conservatism can lead to misinterpretation as more frequent entities, such as a contracted gallbladder, sometimes prompting unnecessary surgical exploration. Awareness of this bias is essential for accurate preoperative diagnosis and for avoiding iatrogenic injury or unwarranted intervention.

Management

Nonoperative management

There are no specific guidelines for the management of gallbladder anomalies; however, as suggested by Malde,¹⁵ nonoperative management is often appropriate for asymptomatic or minimally symptomatic patients. Gallbladder agenesis, for instance, may present with right upper quadrant pain, dyspepsia, jaundice, fatty food intolerance, or nausea, making diagnosis challenging due to symptom overlap with other biliary conditions. These symptoms are attributed to biliary dyskinesia, choledocholithiasis, or like postcholecystectomy syndrome. In symptomatic cases, management may include smooth muscle relaxants or sphincterotomy if symptoms persist.⁴⁵ Similarly, duplicated or bilobed gallbladders, when discovered incidentally, do not typically require surgical intervention unless symptomatic. These anatomical variations are generally of little clinical significance and are managed nonoperatively unless complications such as gallstones or inflammation arise. Nonoperative management remains the preferred approach in such cases.⁴⁶

Surgical management

For symptomatic gallbladder diseases, the treatment of choice is cholecystectomy, even in the presence of anatomical anomalies. Minimally invasive approaches, such as laparoscopic or robotic cholecystectomy, are preferred. However, if anatomical delineation proves challenging, timely conversion to an open approach is recommended.

In cases of gallbladder anomalies, IOC should be utilized routinely to accurately identify biliary anatomy and minimize the risk of bile duct injury as it is not uncommon to have concurrent biliary anatomical variance as stated above. Additionally, indocyanine green (ICG) with near-infrared (NIR) fluorescence imaging can serve as a valuable adjunct to map extrahepatic biliary structures.⁴⁷

Although this review focuses specifically on gallbladder anomalies, it is important to recognize that concurrent biliary and/or vascular variations are common. When such anomalies are identified or suspected preoperatively, careful evaluation of the vascular anatomy—particularly hepatic artery variants—is essential to guide safe surgical planning and minimize complications. Awareness of potential vascular variations, in conjunction with detailed preoperative triphasic cross-sectional imaging, can enhance the surgeon’s ability to anticipate and prevent technical challenges during cholecystectomy in patients with known or suspected gallbladder anomalies.

For concurrent biliary anomalies such as Cholecystohepatic duct (hepaticocholecystic duct) require special consideration. These anomalies are difficult to detect preoperatively and more often diagnosed at the time of surgical intervention. If there is a concern based on initial evaluation for such an anomaly, MRCP or ERCP should be performed for proper anatomical delineation and operative planning. If bilioenteric continuity cannot be preserved during cholecystectomy, a hepaticojejunostomy may be necessary.⁴⁸

If anatomical structures cannot be clearly visualized or if the critical view of safety during minimally invasive approach cannot be obtained, alternative strategies such as subtotal cholecystectomy, a top-down approach, or conversion to open should be considered.^49,50 Intraoperative consultation with a hepatobiliary surgeon or transfer to a tertiary facility may be prudent in complex cases. Furthermore, in the event of a bile duct injury in the setting of gallbaldder anomaly, patients should be promptly referred to a specialist at a center with a multidisciplinary hepatobiliary team, as outcomes are significantly improved when repairs are attempted at specialized centers.⁵⁰ When a gallbladder anomaly is suspected intraoperatively, surgeons should maintain a low threshold for performing IOC before extensive dissection. When the gallbladder is difficulty to identify, direct needle puncture and contrast injection into the CHD or CBD can provide unequivocal delineation of the biliary tract and prevent iatrogenic injury.

Prognosis and Follow-Up

The prognosis for gallbladder anomalies largely depends on the severity of the anomaly and associated complications. When identified early and managed appropriately, outcomes are generally favorable. However, untreated or misdiagnosed anomalies may lead to complications such as biliary obstruction, cholangitis, or bile duct injury during cholecystectomy, significantly impacting patient health.

For asymptomatic patients with gallbladder anomalies, intervention is typically unnecessary. These patients can be monitored for signs of biliary obstruction or infection. However, they may require a follow up with a surgeon who is familiar with gallbladder anomaly in case any related symptoms develop.

For symptomatic patients with known gallbladder anomalies, surgical intervention by appropriate expertise is essential for achieving optimal clinical outcomes. In case of isolated gallbladder anomalies, follow-up imaging is typically not required after cholecystectomy. However, patients with concurrent biliary or vascular anomalies may benefit from periodic imaging, such as abdominal US or MRI, to monitor potential issues such as bile duct strictures, recurrent choledocholithiasis or hepatolithiasis, or cholangitis. Appropriate follow-up allows for early detection of complications, ensuring timely management and improving long-term outcomes.

CONCLUSION

Gallbladder anomalies, though rare, pose notable challenges in both diagnosis and management. These congenital variations, arising from disruptions during embryological gallbladder development, can lead to various complications if not accurately identified prior to surgical interventions. Our systematic review underscores the critical importance of thorough preoperative evaluation and early detection, particularly in patients undergoing cholecystectomy.

While often discovered incidentally, gallbladder anomalies have the potential to mimic common biliary pathologies, necessitating a high index of clinical suspicion. Advanced imaging modalities, such as contrast-enhanced MRI with MRCP, are invaluable tools in distinguishing these anomalies and avoiding misdiagnosis and unnecessary surgical procedures.

This review highlights the need for heightened awareness and understanding of these anomalies among clinicians and surgeons. Failure to recognize gallbladder anomalies can result in severe postoperative complications, including bile duct injuries, bile leaks, and recurrence of gallstone disease. Further studies and the establishment of standardized management guidelines will be instrumental in improving patient care and addressing the gaps in the current literature.