Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

Abstract

Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

MRCP and microincision of the cystic duct can prevent residual gallstones: A single-center experience

“…Furthermore, MRCP examination can reduce the missed diagnosis rate by 7.98%, making the examination quite valuable in terms of cost and long-term e cacy. Consistent with our data, the study by Rao et al showed that among 106 patients with newly diagnosed gallstones, 16% of had choledocholithiasis, and in 6% of the total, the choledocholithiasis could not be detected by ultrasonography and but was detected by MRCP [23]. Anwar et al reported that for common bile duct stones, the sensitivity of abdominal ultrasound was only 78.2%, while the sensitivity of MRCP was as high as 92%, with mostly sedimentary stones in false-negative cases [24].…”

Pre Operative Magnetic Resonance Cholangiopancreatography in Laparoscopic Cholecystectomy with Special Reference to Hepatobiliary Anatomic Variations and Undetected Choledocholithiasis

“…In current study we found that male patients were more common after the age of 50 years as maximum number of male patients were present in age group 51-70 years (11 patients, 68.75%) while female patients were more common in age group 18 to 50 years (32 patients, 61.5%). In study by Rao GB et al 13 , male patients were common in age group 41-70 years (19 patients) while female patients were common in age group 21-40 years (27 patients).…”