Preoperative assessment for feasibility of laparoscopic cholecystectomy using magnetic resonance cholangiography.
OBJECTIVE
We present the results of classification of magnetic resonance cholangiography (MRC) focusing upon visualization of cystic duct for preoperative laparoscopic cholecystectomy (LC), along with assessments of a possible correlation between MRC classification and feasibility of LC.


METHODS
The study included a total of 663 patients who were diagnosed as cholelithiasis. MRC were classified into four types: Type A; entire biliary tract was visualized (+), Type B; cystic duct (+) but gallbladder was not(-), Type C; gallbladder (+), cystic duct (-), and Type D; gallbladder (-), cystic duct (-). The feasibility of LC was assessed using the following two variables: 1) percentages of cases in which LC was changed to open cholecystectomy (OC) and 2) operating time. The results were compared in respect of the relationship with the MRC classification.


RESULTS
MRC were classified as follows: Type A (58.4%), Type B (15.2%), Type C (19.3%) and Type D (7.1%). A total of 124 patients (18.7%) had chronic cholecystitis, and a strong correlation with MRC type was noted (p<0.0001). In 46 patients (7.5%), the surgical procedure was changed from LC to OC. The percentages of cases in which LC was changed to OC was significantly higher for Type C and Type D (p<0.0001), so these two groups demonstrated prolonged operating time.


CONCLUSIONS
Our MRC classification based on the visualization of cystic duct can reflect the feasibility of LC, and LC may be less feasible tin Type C, and in particular Type D patients.
Shiozawa
Shunichi
S
Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Tsuchiya
Akira
A
Kim
Dal Ho
DH
Usui
Takebumi
T
Inose
Satoshi
S
Aizawa
Masaki
M
Masuda
Toshio
T
Yoshimatsu
Kazuhiko
K
Katsube
Takao
T
Naritaka
Yoshihiko
Y
Ogawa
Kenji
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography / Q000145:classification*; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery; D002908:Chronic Disease; D003549:Cystic Duct / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055815:Young Adult