Preoperative assessment for feasibility of laparoscopic cholecystectomy using magnetic resonance cholangiography

Hepatogastroenterology. 2008 Nov-Dec;55(88):1955-7.

Abstract

Background/aims: We present the results of classification of magnetic resonance cholangiography (MRC) focusing upon visualization of cystic duct for preoperative laparoscopic cholecystectomy (LC), along with assessments of a possible correlation between MRC classification and feasibility of LC.

Methodology: The study included a total of 663 patients who were diagnosed as cholelithiasis. MRC were classified into four types: Type A; entire biliary tract was visualized (+), Type B; cystic duct (+) but gallbladder was not(-), Type C; gallbladder (+), cystic duct (-), and Type D; gallbladder (-), cystic duct (-). The feasibility of LC was assessed using the following two variables: 1) percentages of cases in which LC was changed to open cholecystectomy (OC) and 2) operating time. The results were compared in respect of the relationship with the MRC classification.

Results: MRC were classified as follows: Type A (58.4%), Type B (15.2%), Type C (19.3%) and Type D (7.1%). A total of 124 patients (18.7%) had chronic cholecystitis, and a strong correlation with MRC type was noted (p<0.0001). In 46 patients (7.5%), the surgical procedure was changed from LC to OC. The percentages of cases in which LC was changed to OC was significantly higher for Type C and Type D (p<0.0001), so these two groups demonstrated prolonged operating time.

Conclusions: Our MRC classification based on the visualization of cystic duct can reflect the feasibility of LC, and LC may be less feasible tin Type C, and in particular Type D patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cholangiography / classification*
  • Cholecystectomy, Laparoscopic*
  • Cholecystitis / surgery
  • Chronic Disease
  • Cystic Duct / diagnostic imaging*
  • Feasibility Studies
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Young Adult