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Surgical Endoscopy
Published in: Surgical Endoscopy 4/2005

01-04-2005 | Original article

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

Authors: C. Ausch, G. Hochwarter, M. Taher, B. Holzer, H. R. Rosen, M. Urban, C. Sebesta, W. Hruby, R. Schiessel

Published in: Surgical Endoscopy | Issue 4/2005

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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.
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Metadata
Title
Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography
Authors
C. Ausch
G. Hochwarter
M. Taher
B. Holzer
H. R. Rosen
M. Urban
C. Sebesta
W. Hruby
R. Schiessel
Publication date
01-04-2005
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 4/2005
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-004-9093-5

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