Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography.
BACKGROUND
The aim of this study was to determine the value of routinely performed preoperative magnetic resonance cholangiography (MRC) in detecting common bile duct (CBD) stones in patients stated to undergo elective laparoscopic cholecystectomy. In addition, we used MRC to investigate possible variants of the cystic duct.


METHODS
Magnetic resonance cholangiography was performed preoperatively in 773 patients (311 male and 462 female; median age 55 years, range 16-91) who had no clinical signs of cholestasis prior to undergoing elective laparoscopic cholecystectomy. In cases where the MRC was positive for CBD stones, endoscopic retrograde cholangiopancreatiography (ERCP) was then performed. A total of 532 patients were available for continuous postoperatively follow-up (median 54 months, range 36-85). In 462 patients (247 female, and 215 male), MR images were also reviewed for variants of the cystic duct.


RESULTS
In 705 patients (91%), MRC was negative for CBD stones. In 64 patients (9%) MRC was positive. Of these patients, 47 (6%) had CBD stones on ERCP. In 12 patients (2%), MRC was false positive. In five cases (0.6%), ERCP had an inconclusive result postoperative follow-up (532 patients, or 69%) revealed evidence of CBD stones in three patients (10.4%) despite a preoperative negative MRC result. Anatomical variants in the course of the cystic duct and its confluence with the common bile duct were found in 27 of 462 patients (6%).


CONCLUSIONS
Magnetic resonance cholangiography proved to be a reliable screening technique in the preoperative evaluation of patients with silent CBD stones. Imaging of the course of the cystic duct is possible in a high percentage of cases. Therefore, MRC can be recommended as a screening technique before laparoscopic cholecystectomy.
Ausch
C
C
Department of Surgery, Danube Hospital, SMZ-Ost, Langobardenstrasse 122, A-1220 Vienna, Austria. christoph.ausch@wienkav.at
Hochwarter
G
G
Taher
M
M
Holzer
B
B
Rosen
H R
HR
Urban
M
M
Sebesta
C
C
Hruby
W
W
Schiessel
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D049448:Cholangiopancreatography, Magnetic Resonance / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D003549:Cystic Duct / Q000000981:diagnostic imaging; D003955:Diagnostic Tests, Routine; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D014644:Genetic Variation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011859:Radiography; D016037:Single-Blind Method