title: Elective laparoscopic cholecystectomy without intraoperative cholangiography: role of preoperative magnetic resonance cholangiopancreatography - a retrospective cohort study.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is the standard treatment for gallbladder diseases. Intraoperative cholangiography (IOC) can reduce biliary complications of LC; however, with the emergence of magnetic resonance cholangiopancreatography (MRCP), IOC nowadays is faced with unprecedented challenge. The purpose of this study is to evaluate whether preoperative MRCP can safely replace IOC during elective LC in terms of retained common bile duct (CBD) stones and bile duct injury (BDI).
  
  
  METHODS
  A retrospective study on candidates for elective LC who underwent IOC or preoperative MRCP between January 2009 and December 2014 was conducted.
  
  
  RESULTS
  In the IOC group, 1972 patients underwent LC and 213 required IOC. In the MRCP group, 2268 patients underwent LC and 257 required MRCP. In the IOC group, the rate of retained CBD stones was 0.45 % without IOC and 1.41 % with IOC. In five of 157 patients who underwent IOC, endoscopic retrograde cholangiopancreatography or laparoscopic CBD exploration showed no evidence of CBD stones. In the MRCP group, the rate of retained CBD stones was 0.45 % without MRCP. No patients with normal MRCP findings returned with symptomatic CBD stones during 1-year follow-up. The rate of BDIs was 0.20 % in the IOC group and 0.13 % in the MRCP group.
  
  
  CONCLUSIONS
  Selective use of preoperative MRCP is an effective and safe strategy when conducting elective LC to treat gallstones. LC resorting to preoperative MRCP can be performed safely without IOC, with an acceptable rate of retained CBD stones and BDIs.
authors.affiliation: Department of Hepatobiliary Surgery, Taizhou People's Hospital, No. 210, Yingchun Road, Taizhou, 225300, Jiangsu Province, China. xkfy1979@126.com.
authors.forename: Jinfeng
authors.identifier: http://orcid.org/0000-0002-0691-9224
authors.initials: J
authors.lastname: Zang
authors.affiliation: Department of Hepatobiliary Surgery, Taizhou People's Hospital, No. 210, Yingchun Road, Taizhou, 225300, Jiangsu Province, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Hepatobiliary Surgery, Taizhou People's Hospital, No. 210, Yingchun Road, Taizhou, 225300, Jiangsu Province, China.
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary Surgery, Taizhou People's Hospital, No. 210, Yingchun Road, Taizhou, 225300, Jiangsu Province, China.
authors.forename: Junye
authors.initials: J
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic; D017558:Elective Surgical Procedures; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Bile duct injury; Common bile duct stones; Intraoperative cholangiography; Laparoscopic cholecystectomy; Magnetic resonance cholangiopancreatography