Value Of MRCP In Improving The Safety Of Laparoscopic Cholecystectomy

ObjectiveThe aim of this study was to determine the value of routinely performed preoperative magnetic resonance cholangiopancreatography(MRCP) in detecting common bile duct(CBD) stones in patients stated to undergo laparoscopic cholecystectomy and investigating possible variants of the extra-hepatic bile duct,to see whether MRCP can improving the safety of laparoscopic cholecystectomy.MATERIALS AND METHODSMagnetic resonance cholangiography was performed preoperatively in 209 patients between 2008.1.1 and 2008.9.30 who would be underwent laparoscopic cholecystectomy.The result of ultrasonograph(US) of these patients present cholecystolithiasis but without CBD stones.In cases where the MRCP was positive for CBD stones,endoscopic retrograde cholangiopancreatiography(ERCP) or intra-operative cholangiography(IOC) was then performed,if CBD stones were confirmed,endoscopic sphencterotomy(EST) or laparoscopic common bile duct exploration(LCBDE) was performed immediately.As MRCP was negative,selectivity IOC were carried out in patients with abnormal liver function test(LFT) or diameter of CBD was large than normal,and LCBDE was performed directly in these patients when IOC detected CBD stones.And the patients,either ERCP/IOC showed negative or IOC was not performed for no risk factors of CBD stones,were followed up for 6 months,LFT and US were tested regularity to definite the final negative of CBD stones. The data including the final modality of operation,time consuming of operation and post-operative hospital stay were collected and analyzed.RESULTSIn total 209 patients(86 male and 123 female,median age 52 years,range 20-87), MRCP was positive for CBD stones in 57 patients,as in 148 patients MRC was negative.Of these patients,63 had CBD stones finally confirmed by ERCP or IOC, and 142 was precisely negative by follow-up.MRCP was false negative in 6 patients. And there was 0 false positive.MRCP's sensitivity,specificity,positive predictive value,negative predictive value,and accuracy on CBD stone were 90.5%,100%, 100%,95.9%,and 97.1%,respectively.Anatomical abnormality were found in 6 patients including:1 case of right accessory hepatic duct which confluence with common hepatic duct,1 case of mirizzi syndrome,2 cases of choledochal cyst and 2 cases of fistula between cholecyst and stomach/duodenum.CONCLUSIONS:Magnetic resonance cholangiography proved to be a reliable screening technique in the preoperative evaluation of patients with CBD stones.Preoperative evaluation of the extra-hepatic bile duct raises the operating surgeon's awareness of variants,that improve the safety of laparoscopic cholecystectomy.Therefore,MRCP can be recommended as a screening technique before laparoscopic cholecystectomy.