Role of preoperative magnetic resonance cholangio-pancreatography in avoiding complicated gall stone surgery

Abstract

Background: Gallstone disease is a common disease responsible for considerable morbidity in the society. Surgery is the definitive treatment and laparoscopic cholecystectomy has largely replaced conventional surgery. However, laparoscopic cholecystectomy carries a higher risk of injury to biliary tree than conventional surgery. Significant number of these injuries is caused by variations in the biliary tree anatomy. By precisely delineating the biliary tree anatomy, magnetic resonance imaging and magnetic resonance cholangiopancreatography can assist the surgeons in predicting difficult surgery. Objective: The present study attempts to determine the role of magnetic resonance imaging and magnetic resonance cholangiopancreatography prior to laparoscopic cholecystectomy in gallstone disease. Method: In the present study, 100 patients with gallstone disease, referred for magnetic resonance imaging and magnetic resonance cholangiopancreatography were evaluated Result: The most common age group to be involved was 4th and 5th decade. Females were almost twice commonly affected than males. The sensitivity of MRI was 95 -100%, specificity 97 – 100% and accuracy 96 - 98% for detecting gallstones. Similar sensitivity and specificity was found for CBD calculi.3. The sensitivity and specificity for delineation of biliary tree anatomy was 100% each. Type A IHBR pattern was seen in 42 %, Type B in 22%, Type C in 26%, Type D in 6% and Type E in 2%. The cystic duct anatomy was delineated with 100% sensitivity and specificity. Anomalous cystic duct insertion patterns were seen in 11%. The incidence of CBD calculus was 7%. The mean diameter of CBD was 5.73±2.65 mm. The gall bladder volume had no statistically significant correlation with difficult surgery. The patterns of IHBR did not have any impact of difficult surgery. However, the pattern of cystic duct insertion had a statistically significant correlation with difficult surgery with anomalous insertions leading to difficult surgery with a p value of 0.025. It was significant on multivariate analysis too with a p value of 0.034. The CBD diameter also had a statistically significant correlation with difficult surgery with a p value of 0.011 on Univariate analysis and 0.021 on multivariate analysis. There were no bile duct injuries or forced conversion to open surgery. The mean operation time was 54.13±33.73 min. Conclusion: MRI and MRCP can accurately detect gallstones and delineate biliary tree anatomy. They can also detect anomalous biliary tree and can predict difficult surgery thus helping the surgeon to be prepared for the eventualities during surgery.

Keywords

• mr cholangiopancreatography
• gall stone surgery
• biliary tract