title: Relationship between the risk of bile duct injury during laparoscopic cholecystectomy and the types of preoperative magnetic resonance cholangiopancreatiocography (MRCP).
abstract: OBJECTIVE
  Bile duct injury is one of the potential severe complications that can occur during laparoscopic cholecystectomy, which can be cause by anatomic variations in the confluence of the bile duct. Recently magnetic resonance cholangiopancreatiocography (MRCP) has become a helpful tool to detect bile duct variation on a preoperative basis and to prevent bile duct injury during laparoscopic cholecystectomy, as well other hepatic surgeries. This study aimed to clarify the types of bile duct on MRCP and to search for a method of avoiding injury during laparoscopic cholecystectomy.
  
  
  METHODS
  Between January 2009 and December 2010, 277 patients underwent laparoscopic cholecystectomy with preoperative MRCP in our institution. On a retrospective basis, the bile ducts were categorized into 5 types according to the Couinaud classification system.
  
  
  RESULTS
  The proportion of types was revealed type A (70.4%), type B (8.7%), type C (19.5%), type D (0.7%), type E (0%), and type F (0.7%), respectively. Bile duct injury occurred in 4 cases (1.4%) during laparoscopic cholecystectomy. In particular, the possibility of aberrant extrahepatic confluence (Type C and F) represented the highest risk of duct injury (OR=11.89 [CI: 1.21-116.53]).
  
  
  CONCLUSIONS
  Preoperative evaluation of the bile duct anatomy is important to avoid injury of duct during laparoscopic cholecystectomy. Specific types of bile duct variation should be considered as a high risk group for bile duct injury.
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Yun Ho
authors.initials: YH
authors.lastname: Chung
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Doo Jin
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: In-Gyu
authors.initials: IG
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Han Jun
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Seong Eun
authors.initials: SE
authors.lastname: Chon
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Jang Yong
authors.initials: JY
authors.lastname: Jeon
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Jung
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Jin Cheol
authors.initials: JC
authors.lastname: Jeong
authors.affiliation: Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Joo Seop
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Yun
keywords: Bile duct; Cholecystectomy; Magnetic resonance cholangiopancreatiocography