Ann Surg Treat Res.  2020 Oct;99(4):221-229. 10.4174/astr.2020.99.4.221.

Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered?

• Kang KA
• Kwon HJ
• Ham SY
• Park HJ
• Shin JH
• Lee SR
• Kim MS

• KMID: 2506653
• DOI: http://doi.org/10.4174/astr.2020.99.4.221

Abstract

Purpose
We evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy.
Methods
We performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP.
Results
There were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed.
Conclusion
MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.

Keyword

Cholecystectomy; Laparoscopic; Magnetic resonance cholangiopancreatography

Figure

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  Fig. 1 Magnetic resonance cholangiography images demonstrate bile duct anomaly that can cause injury. (A) Aberrant drainage of the cystic duct (arrow) to the right hepatic duct (arrowhead). (B) Aberrant drainage of the right anterior hepatic duct (arrow) to the cystic duct (arrowhead). (C) Short cystic duct (length, <5 mm; arrow). (D) Long, posterior spiral course of cystic duct with medial insertion to common bile duct (arrow).

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