Elective Laparoscopic Cholecystectomy Without Intraoperative Cholangiography: Role of Preoperative Magnetic Resonance Cholangiopancreatography - a Retrospective Cohort Study

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2016 Jul 15

PMID 27411676

Citations 7

Authors

Jinfeng Zang

Yin Yuan

Chi Zhang

Junye Gao

Affiliations

Soon will be listed here.

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.

Citing Articles

Systematic intraoperative cholangiography during elective laparoscopic cholecystectomy: Is it a justifiable practice?.

Esposito F, Scoleri I, Cattan R, Cook M, Sacrieru D, Meziani N Ann Hepatobiliary Pancreat Surg. 2023; 27(2):166-171.

PMID: 36653318 PMC: 10201056. DOI: 10.14701/ahbps.22-099.

Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis.

Kovacs N, Nemeth D, Foldi M, Nagy B, Bunduc S, Hegyi P Surg Endosc. 2022; 36(10):7126-7139.

PMID: 35794500 PMC: 9485186. DOI: 10.1007/s00464-022-09267-x.

Association Between Cholecystectomy and Gastric Cancer Risk: A Systematic Review and Meta-Analysis.

Yang Y, Liu M, Li Y Front Oncol. 2022; 12:667736.

PMID: 35174075 PMC: 8841561. DOI: 10.3389/fonc.2022.667736.

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?.

Donnellan E, Coulter J, Mathew C, Choynowski M, Flanagan L, Bucholc M Surg Open Sci. 2021; 3:8-15.

PMID: 33937738 PMC: 8076912. DOI: 10.1016/j.sopen.2020.07.004.

Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary?.

Rhaiem R, Piardi T, Renard Y, Chetboun M, Aghaei A, Hoeffel C J Res Med Sci. 2020; 24:107.

PMID: 31949458 PMC: 6950362. DOI: 10.4103/jrms.JRMS_281_19.

References

Traverso L . Intraoperative cholangiography lowers the risk of bile duct injury during cholecystectomy. Surg Endosc. 2006; 20(11):1659-61. DOI: 10.1007/s00464-006-0122-4. View

Nuzzo G, Giuliante F, Giovannini I, Ardito F, DAcapito F, Vellone M . Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg. 2005; 140(10):986-92. DOI: 10.1001/archsurg.140.10.986. View

Sirinek K, Schwesinger W . Has intraoperative cholangiography during laparoscopic cholecystectomy become obsolete in the era of preoperative endoscopic retrograde and magnetic resonance cholangiopancreatography?. J Am Coll Surg. 2015; 220(4):522-8. DOI: 10.1016/j.jamcollsurg.2014.12.043. View

Sanjay P, Fulke J, Exon D . 'Critical view of safety' as an alternative to routine intraoperative cholangiography during laparoscopic cholecystectomy for acute biliary pathology. J Gastrointest Surg. 2010; 14(8):1280-4. DOI: 10.1007/s11605-010-1251-6. View

Ford J, Soop M, Du J, Loveday B, Rodgers M . Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg. 2011; 99(2):160-7. DOI: 10.1002/bjs.7809. View

Massarweh N, Devlin A, Broeckel Elrod J, Symons R, Flum D . Surgeon knowledge, behavior, and opinions regarding intraoperative cholangiography. J Am Coll Surg. 2009; 207(6):821-30. DOI: 10.1016/j.jamcollsurg.2008.08.011. View

Lill S, Rantala A, Pekkala E, Sarparanta H, Huhtinen H, Rautava P . Elective laparoscopic cholecystectomy without routine intraoperative cholangiography: a retrospective analysis of 1101 consecutive cases. Scand J Surg. 2010; 99(4):197-200. DOI: 10.1177/145749691009900403. View

Sheffield K, Riall T, Han Y, Kuo Y, Townsend Jr C, Goodwin J . Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury. JAMA. 2013; 310(8):812-20. PMC: 3971930. DOI: 10.1001/jama.2013.276205. View

Metcalfe M, Ong T, Bruening M, Iswariah H, Wemyss-Holden S, Maddern G . Is laparoscopic intraoperative cholangiogram a matter of routine?. Am J Surg. 2004; 187(4):475-81. DOI: 10.1016/j.amjsurg.2003.12.047. View

10.

Alvarez F, de Santibanes M, Palavecino M, Sanchez Claria R, Mazza O, Arbues G . Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg. 2014; 101(6):677-84. DOI: 10.1002/bjs.9486. View

11.

Videhult P, Sandblom G, Rasmussen I . How reliable is intraoperative cholangiography as a method for detecting common bile duct stones? : A prospective population-based study on 1171 patients. Surg Endosc. 2008; 23(2):304-12. DOI: 10.1007/s00464-008-9883-2. View

12.

Ausch C, Hochwarter G, Taher M, Holzer B, Rosen H, Urban M . Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography. Surg Endosc. 2005; 19(4):574-80. DOI: 10.1007/s00464-004-9093-5. View

13.

Epelboym I, Winner M, Allendorf J . MRCP is not a cost-effective strategy in the management of silent common bile duct stones. J Gastrointest Surg. 2013; 17(5):863-71. DOI: 10.1007/s11605-013-2179-4. View

14.

Pesce A, Portale T, Minutolo V, Scilletta R, Li Destri G, Puleo S . Bile duct injury during laparoscopic cholecystectomy without intraoperative cholangiography: a retrospective study on 1,100 selected patients. Dig Surg. 2012; 29(4):310-4. DOI: 10.1159/000341660. View

15.

Byrne M, McLoughlin M, Mitchell R, Gerke H, Kim K, Pappas T . For patients with predicted low risk for choledocholithiasis undergoing laparoscopic cholecystectomy, selective intraoperative cholangiography and postoperative endoscopic retrograde cholangiopancreatography is an effective strategy to limit.... Surg Endosc. 2009; 23(9):1933-7. DOI: 10.1007/s00464-008-0250-0. View

16.

Bahram M, Gaballa G . The value of pre-operative magnetic resonance cholangiopancreatography (MRCP) in management of patients with gall stones. Int J Surg. 2010; 8(5):342-5. DOI: 10.1016/j.ijsu.2010.03.006. View

17.

Dooms G, Fisher M, Higgins C, Hricak H, GOLDBERG H, Margulis A . MR imaging of the dilated biliary tract. Radiology. 1986; 158(2):337-41. DOI: 10.1148/radiology.158.2.3941860. View

18.

Chang J, Lee I, Lim Y, Jung S, Paik C, Kim H . Role of magnetic resonance cholangiopancreatography for choledocholithiasis: analysis of patients with negative MRCP. Scand J Gastroenterol. 2011; 47(2):217-24. DOI: 10.3109/00365521.2011.638394. View

19.

Holmes L, Ausania F, Iype S, Ricci P, White S . Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?. Surg Endosc. 2012; 26(5):1193-200. DOI: 10.1007/s00464-012-2241-4. View

20.

Fogli L, Boschi S, Patrizi P, Berta R, Al Sahlani U, Capizzi D . Laparoscopic cholecystectomy without intraoperative cholangiography: audit of long-term results. J Laparoendosc Adv Surg Tech A. 2009; 19(2):191-3. DOI: 10.1089/lap.2008.0268. View