The Variation of Hepatic Duct Confluence and Asymptomatic Common Bile Duct Stone with Routine Intraoperative Cholangiogram during Laparoscopic Cholecystectomy

Abstract

Background/Aims: Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone. Methods: We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively. Results: Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud's classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones. Conclusions: Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct. (Korean J Gastroenterol 2011;58:338-345)

Migration of the Plastic Clips of the Cystic Ducts to the Bile Duct Post-Laparoscopic Cholecystectomy: A Case Report

“…Some patient factors, such as obesity, diabetes mellitus, and advanced age, may also increase the risk of clip migration. 3,4 675 After laparoscopic cholecystectomy, a clip is placed in the cystic duct to prevent bile leakage. However, in some cases, the clip can detach from the cystic duct and migrate to the bile duct.…”

The Diagnostic Value of GGT‐Based Biochemical Indicators for Choledocholithiasis with Negative Imaging Results of Magnetic Resonance Cholangiopancreatography

“…For gallbladder stones combined with symptomatic common bile duct stones, the clinician can easily confirm the diagnosis preoperatively. However, some patients with cholecystolithiasis combined with choledocholithiasis are easily missed by clinicians due to asymptomatic choledocholithiasis [ 3 ]. If these patients only undergo laparoscopic cholecystectomy (LC), residual postsurgical common bile duct stones will be at risk of complications such as acute cholangitis and acute membranous adenitis [ 4 ].…”

A case report of intrahepatic bile duct confluence anomalies in VACTERL syndrome

“…The anatomical variability of the biliary system has been well described; however, most cases of drain variability involve portions of the right liver to join the main biliary tract, rather than the left liver and gallbladder. [ 4 – 6 ] Direct drainage of the segment 3 bile duct into the neck of the gallbladder is also seldom reported.…”