The Guidance Impact of Preoperative Magnetic Resonance Cholangiopancreatography on Laparoscopic Cholecystectomy

Zhang, Changhe; Yin, Ming; Liu, Qinghong

doi:10.1089/lap.2014.0485

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…MRCP is a noninvasive imaging modality which can optimally image the bile ducts and cystic duct. Studies have shown that preoperative MRCP provides important information regarding cystic duct anatomy and has a significant safeguarding effect on laparoscopic cholecystectomy [ 6 – 8 ]. Prior knowledge of the cystic duct anatomy and its variants helps in proper interpretation of disease process and avoids iatrogenic injuries.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

Sarawagi

Sundar

Gupta

et al. 2016

Radiology Research and Practice

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Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented. Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst. Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

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Section: Discussionmentioning

confidence: 99%

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

Sarawagi

Sundar

Gupta

et al. 2016

Radiology Research and Practice

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“…Under this notion and taking into account additionally the great anatomical variability of the extrahepatic biliary tree, it becomes evident that accurate pre-operative planning could play a crucial role in performing a safe cholecystectomy, particularly for the majority of general surgeons who do not have specialist hepatobiliary experience [ 2 , 3 ]. As a result, the liberal use of pre-operative magnetic resonance cholangiopancreatography (MRCP) is gaining popularity as a roadmap prior to cholecystectomy, aiming to assess primarily for the presence of migrated gallstones within the cystic duct or common bile duct, as well as providing information regarding the anatomical features of the extrahepatic biliary tree on an individualised basis [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Routine extensive dissection of the cystic duct during laparoscopic cholecystectomy to reduce the risk of residual choledocholithiasis: an unnecessary step and a potentially hazardous concept

Seretis¹,

Zohdy²,

Padgett³

et al. 2022

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Introduction Post-cholecystectomy choledocholithiasis can occur from retained stones at the cystic duct stump remnant; however, most surgeons would not proceed with extensive dissection of the cystic duct during routine cholecystectomy, mainly in fear of inadvertent bile duct injuries, given the frequent anatomical variations of the extrahepatic biliary tree. Aim To determine the need and feasibility of extensive dissection of the cystic duct during laparoscopic cholecystectomy, to reduce the risk of post-cholecystectomy choledocholithiasis. Material and methods We performed a retrospective review of our institutional database of all patients who had magnetic resonance cholangiopancreatography (MRCP) prior to cholecystectomy over a 3-year period (03/2016-04/2019), assessing the anatomical variations of the cystic duct and the incidence of cystic duct stones. Results During the study period, from a total of 763 patients who underwent cholecystectomy for symptomatic gallstones, 284 had undergone pre-operative MRCP and were all included in the final analysis. The typical right lateral insertion of the cystic duct in the midpoint between the confluence of the main hepatic ducts and the ampulla of Vater was identified in less than 50% of the patients. In our series, cystic duct stones were present only in 1.8% of our patients. Conclusions The presence of significant anatomical variations and the low likelihood of incidental cystic duct stones render prophylactic extensive dissection of the cystic duct during standard laparoscopic cholecystectomy a rather unnecessary and probably hazardous step.

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“…The MRCP is a noninvasive imaging technique for optimally visualizing the cystic duct and bile ducts. According to studies, MRCP offers essential information on the structure of the cystic duct pre-operatively and has a significant protective role on laparoscopic cholecystectomy[15][16][17]. Prior knowledge of the cystic duct's anatomy and its variations benefits in the appropriate understanding of the disease process and…”

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confidence: 99%

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography: A Retrospective Study With 265 Patients

Agarwal¹,

Choudhury²,

Biswas³

et al. 2022

IJAR

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Background: Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives: The purpose of our study was to demonstrate the imaging features of cystic duct and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods: This study included 265 patients who underwent magnetic resonance cholangiopancreatography due to different indications and variations of cystic duct were documented. Results: Normal lateral insertion of cystic duct at middle third of common hepatic duct was seen in 29.43% of cases. Medial insertion was seen in 2.63% of cases, 2.26% were low medial insertions. Low insertion of cystic duct was noted in 1.51 % of cases. Parallel course of cystic duct was present in 0.38% of cases. High insertion was noted in 0.38% cases and no case of short cystic duct was noted. No case of cystic duct draining into right hepatic duct was seen. Conclusion: Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy. KEY WORDS: Cystic Duct, Hepatic Duct, Variation, MRCP.

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The Guidance Impact of Preoperative Magnetic Resonance Cholangiopancreatography on Laparoscopic Cholecystectomy

Abstract: Our results demonstrated that preoperative MRCP had a robust safeguarding effect on LC and deserves further promotion.

Cited by 8 publications

References 14 publications

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

Routine extensive dissection of the cystic duct during laparoscopic cholecystectomy to reduce the risk of residual choledocholithiasis: an unnecessary step and a potentially hazardous concept

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography: A Retrospective Study With 265 Patients

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