Skip to main content

Advertisement

SpringerLink
Log in

Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to determine the value of routinely performed preoperative magnetic resonance cholangiography (MRC) in detecting common bile duct (CBD) stones in patients stated to undergo elective laparoscopic cholecystectomy. In addition, we used MRC to investigate possible variants of the cystic duct.

Methods

Magnetic resonance cholangiography was performed preoperatively in 773 patients (311 male and 462 female; median age 55 years, range 16–91) who had no clinical signs of cholestasis prior to undergoing elective laparoscopic cholecystectomy. In cases where the MRC was positive for CBD stones, endoscopic retrograde cholangiopancreatiography (ERCP) was then performed. A total of 532 patients were available for continuous postoperatively follow-up (median 54 months, range 36–85). In 462 patients (247 female, and 215 male), MR images were also reviewed for variants of the cystic duct.

Results

In 705 patients (91%), MRC was negative for CBD stones. In 64 patients (9%) MRC was positive. Of these patients, 47 (6%) had CBD stones on ERCP. In 12 patients (2%), MRC was false positive. In five cases (0.6%), ERCP had an inconclusive result postoperative follow-up (532 patients, or 69%) revealed evidence of CBD stones in three patients (10.4%) despite a preoperative negative MRC result. Anatomical variants in the course of the cystic duct and its confluence with the common bile duct were found in 27 of 462 patients (6%).

Conclusions

Magnetic resonance cholangiography proved to be a reliable screening technique in the preoperative evaluation of patients with silent CBD stones. Imaging of the course of the cystic duct is possible in a high percentage of cases. Therefore, MRC can be recommended as a screening technique before laparoscopic cholecystectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. MA Barish EK Yucel JT Ferrucci (1999) ArticleTitleMagnetic resonance cholangiopancreatography New Engl J Med 341 258–264 Occurrence Handle10.1056/NEJM199907223410407 Occurrence Handle1:STN:280:DyaK1MzivVCqug%3D%3D Occurrence Handle10413739

    Article  CAS  PubMed  Google Scholar 

  2. CD Becker M Grossholz M Becker G Mentha R Peyer F Terrier (1997) ArticleTitleCholedocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography Radiology 205 523–530 Occurrence Handle1:STN:280:DyaK1c%2FhvFCmsA%3D%3D Occurrence Handle9356639

    CAS  PubMed  Google Scholar 

  3. R Bittner (2004) ArticleTitleThe standard of laparoscopic cholecystectomy Langenbecks Arch Surg 389 157–163 Occurrence Handle10.1007/s00423-004-0471-1 Occurrence Handle1:STN:280:DC%2BD2c3oslCrtw%3D%3D Occurrence Handle15188083

    Article  CAS  PubMed  Google Scholar 

  4. LH Blumgart (1988) Surgery of the liver and biliary tract Churchill Livingstone London

    Google Scholar 

  5. I Braghetto A Debandi O Korn J Bastias (1998) ArticleTitleLong-term follow-up after laparoscopic cholecystectomy without routine intraoperative cholangiography Surg Laparosc Endosc 8 349–352 Occurrence Handle10.1097/00019509-199810000-00005 Occurrence Handle1:STN:280:DyaK1M%2FhtlCrtA%3D%3D Occurrence Handle9799142

    Article  CAS  PubMed  Google Scholar 

  6. Y Chan AW Chan WM Lam DH Lee SC Chung JY Sung HS Cheung et al. (1996) ArticleTitleCholedocholithiasis: comparison of MR cholangiography and endoscopic retrograde cholangiography Radiology 200 85–89 Occurrence Handle1:STN:280:BymB2MjhsVA%3D Occurrence Handle8657949

    CAS  PubMed  Google Scholar 

  7. FV Coakley LH Schwartz (1999) ArticleTitleMagnetic resonance cholangiopancreatography J Magn Reson Imaging 9 157–162 Occurrence Handle10.1002/(SICI)1522-2586(199902)9:2<157::AID-JMRI2>3.0.CO;2-N Occurrence Handle1:STN:280:DyaK1M7nsVKhtA%3D%3D Occurrence Handle10077008

    Article  CAS  PubMed  Google Scholar 

  8. AM Davidoff TN Pappas EA Murray DJ Hillern RD Johnson ME Baker GE Newman et al. (1991) ArticleTitleMechanisms of major biliary injury during laparoscopic cholecystectomy Ann Surg 215 196–202

    Google Scholar 

  9. PJ Doyle JN Ward-McQuaid A McEwen-Smith (1982) ArticleTitleThe value of routine preoperative cholangiography: a report of 4000 cholecystectomies Br J Surg 69 617–619 Occurrence Handle1:STN:280:BiyD38zpsVY%3D Occurrence Handle7127045

    CAS  PubMed  Google Scholar 

  10. JL FIowers KA Zucker SM Graham WA Srawill AL Imbembo RW Barley (1992) ArticleTitleLaparoscopic cholangiography Ann Surg 215 209–216 Occurrence Handle1531915

    PubMed  Google Scholar 

  11. AS Fulcher MA Turner GW Capps AM Zfass KM Baker (1998) ArticleTitleHalf-fourier RARE MR cholangiopancreaticography: experience in 300 subjects Radiology 207 21–32 Occurrence Handle1:STN:280:DyaK1c7ptFeksw%3D%3D Occurrence Handle9530295

    CAS  PubMed  Google Scholar 

  12. EJ Gibney (1990) ArticleTitleAsymptomatic gallstones Br J Surg 77 868–372

    Google Scholar 

  13. K Hirao A Miyazaki T Fujimoto I Isomoto K Hayashi (2000) ArticleTitleEvaluation of aberrant bile ducts before laparoscopic cholecystectomy: helical CT cholangiography versus MR cholangiography Am. J. Roentgenol 175 713–720 Occurrence Handle1:STN:280:DC%2BD3cvnsFarug%3D%3D

    CAS  Google Scholar 

  14. A Kitahama MD Kerstein MD Kappelmann WR Webb (1986) ArticleTitleRoutine intraoperative cholangiogram Surg Gynecol Obstetr 162 317–322 Occurrence Handle1:STN:280:BimC1c%2FjsFI%3D

    CAS  Google Scholar 

  15. Y Kurumi T Tani K Hanasawa M Kodoma (2000) ArticleTitleThe prevention of bile duct injury during laparoscopic cholecystectomy from the point of view of anatomic variation Surg Laparosc Endosc Percutan Tech 10 192–199 Occurrence Handle10.1097/00019509-200008000-00002 Occurrence Handle1:STN:280:DC%2BD3M%2Fmt1eqsA%3D%3D Occurrence Handle10961744

    Article  CAS  PubMed  Google Scholar 

  16. CJ Leon (1993) ArticleTitleIs laparoscopic cholecystectomy without intraoperative cholangiography a safe operation? Surg Laparosc Endosc 3 523–524 Occurrence Handle1:STN:280:ByuD1MvgslU%3D Occurrence Handle8269273

    CAS  PubMed  Google Scholar 

  17. JM Manson (2000) ArticleTitleIntraoperative cholangiography and bile duct injury in laparoscopic cholecystectomy Surg Endosc 14 94–95 Occurrence Handle10.1007/s004649900023 Occurrence Handle1:STN:280:DC%2BD3c7hs12nuw%3D%3D Occurrence Handle10653248

    Article  CAS  PubMed  Google Scholar 

  18. G McEntee PA Grace D Bouchier-Hayes (1991) ArticleTitleLaparoscopic cholecystectomy and the common bile duct Br J Surg 78 385–386 Occurrence Handle1:STN:280:By6B3svpvFM%3D Occurrence Handle1827747

    CAS  PubMed  Google Scholar 

  19. Neubrand, M, Sackmann, M, Caspary, WF, Feussner, H, Schild, H, Lauchart, W, Schildberg, FW, Reiser, M, Classen, Paumgartner, G, Sauerbruch (2000) “Guidelines by the German Society of Digestive and Metabolic Diseases for treatment of gallstones. German Society of Digestive and Metabolic Diseases” E Gastroenterol 38: 449–468

  20. SA Mitchell MR Jacyna S Chadwick (1993) ArticleTitleCommon bile duct stones: a controversy revisited Br J Surg 80 759–760 Occurrence Handle1:STN:280:ByyA387gsV0%3D Occurrence Handle8330169

    CAS  PubMed  Google Scholar 

  21. JB Morris R Margolis EF Rossati (1993) ArticleTitleSafe laparoscopic cholecystectomy without intraoperative cholangiography J Laparosc Endosc 3 17–20 Occurrence Handle1:STN:280:ByuD1c%2FlslM%3D

    CAS  Google Scholar 

  22. C Nies F Bauknecht C Groth T Clerici D Bartsch J Lange M Rothmund (1997) ArticleTitleIntraoperative Cholangiographie als Routinemethode?, Chirurg 68 892–897 Occurrence Handle10.1007/s001040050290 Occurrence Handle1:STN:280:DyaK1c%2FgtFOqug%3D%3D Occurrence Handle9410677

    Article  CAS  PubMed  Google Scholar 

  23. F Regan J Fradin R Khazan M Bohlman T Magnuson (1996) ArticleTitleCholedocholithiasis: evaluation with MR cholangiography AJR 167 1441–1445 Occurrence Handle1:STN:280:ByiC3Mrhslc%3D Occurrence Handle8956574

    CAS  PubMed  Google Scholar 

  24. NJ Soper DL Dunnegan (1992) ArticleTitleRoutine versus selective intra-operative cholangiography during laparoscopic cholecystectomy World J Surg 16 1133–1140 Occurrence Handle1:STN:280:ByyD1cfot1E%3D Occurrence Handle1455885

    CAS  PubMed  Google Scholar 

  25. JA Soto MA Barish EK Yucel D Siegenbery T Ferruci R Chuttanu (1996) ArticleTitleMagnetic resonance cholangiography: comparison with endoscopic retrograde cholangiopancreatography Gastroenterology 110 589–597 Occurrence Handle1:STN:280:BymC2Mngs1c%3D Occurrence Handle8566608

    CAS  PubMed  Google Scholar 

  26. Southern Surgeons Club (1991) ArticleTitleA prospective analysis of 1518 laparoscopic cholecystectomies New Engl J Med 324 1073–1078 Occurrence Handle1826143

    PubMed  Google Scholar 

  27. RK Tompkins HA Pitt (1982) ArticleTitleSurgical management of benign lesions of the bile ducts Curr Probl Surg 19 321–398 Occurrence Handle1:STN:280:BiyD3c3psFc%3D Occurrence Handle6749439

    CAS  PubMed  Google Scholar 

  28. MA Turner AS Fulcher (2001) ArticleTitleThe cystic duct: normal anatomy and disease processes Radiographics 21 3–22 Occurrence Handle1:STN:280:DC%2BD3MzgtFCisA%3D%3D Occurrence Handle11158640

    CAS  PubMed  Google Scholar 

  29. M Urban B Holzer C Sebesta A Schmid R Schiessel W Hruby H Rosen (2002) ArticleTitleEfficacy of diagnosis of mechanical cholestasis by magnetic resonance cholangiography (MRC) World J Surg 26 353–358 Occurrence Handle10.1007/s00268-001-0232-z Occurrence Handle11865374

    Article  PubMed  Google Scholar 

  30. D Vanbeckevoort L Hoe ParticleVan E Ponette G Marchal H Bosmans B Clercq ParticleDe R Aerts et al. (1997) ArticleTitleImaging of gallbladder and billiary tract before laparoscopic cholecystectomie: comparison of intravenous cholangiography, the combined use of HASTE and single-shot RARE MR imaging J Belg Radiol 80 6–8 Occurrence Handle1:STN:280:ByiB2MjgtlE%3D Occurrence Handle9103705

    CAS  PubMed  Google Scholar 

  31. SH Zidi F Prat OL Le Guen Y Rondeau Z Rocher J Fritsch AD Choury G Pelletier (1999) ArticleTitleUse of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method Gut 44 118–122 Occurrence Handle1:STN:280:DyaK1M%2FotFKltQ%3D%3D Occurrence Handle9862837

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Danube Hospital, SMZ-Ost, Langobardenstrasse 122, A-1220, Vienna, Austria

    C. Ausch, G. Hochwarter, B. Holzer, H. R. Rosen, C. Sebesta & R. Schiessel

  2. Institute of Radiology, Danube Hospital, SMZ-Ost, Langobardenstrasse 122, A-1220, Vienna, Austria

    M. Taher, M. Urban & W. Hruby

Authors
  1. C. Ausch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Hochwarter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Taher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Holzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. R. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Urban
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Sebesta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W. Hruby
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Schiessel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Ausch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ausch, C., Hochwarter, G., Taher, M. et al. Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography. Surg Endosc 19, 574–580 (2005). https://doi.org/10.1007/s00464-004-9093-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-004-9093-5

Keywords

Search

Navigation