Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography
| Autor: | H. R. Rosen, B. Holzer, C. Sebesta, R Schiessel, G. Hochwarter, M. Taher, W. Hruby, Christoph Ausch, M. Urban |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Cholangiopancreatography Magnetic Resonance medicine.medical_treatment digestive system Cholangiography Cholestasis Cholelithiasis Preoperative Care medicine Humans Single-Blind Method Aged Aged 80 and over Common Bile Duct Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test Common bile duct Diagnostic Tests Routine business.industry Gallbladder Cystic Duct Genetic Variation Middle Aged medicine.disease Endoscopy Radiography Choledocholithiasis medicine.anatomical_structure Cholecystectomy Laparoscopic Elective Surgical Procedures Cystic duct Female Surgery Cholecystectomy Radiology business Algorithms Dilatation Pathologic Follow-Up Studies |
| Zdroj: | Surgical Endoscopy. 19:574-580 |
| ISSN: | 1432-2218 0930-2794 |
| Popis: | The aim of this study was to determine the value of routinely performed preoperative magnetic resonance cholangiography (MRC) in detecting common bile duct (CBD) stones in patients stated to undergo elective laparoscopic cholecystectomy. In addition, we used MRC to investigate possible variants of the cystic duct. Magnetic resonance cholangiography was performed preoperatively in 773 patients (311 male and 462 female; median age 55 years, range 16–91) who had no clinical signs of cholestasis prior to undergoing elective laparoscopic cholecystectomy. In cases where the MRC was positive for CBD stones, endoscopic retrograde cholangiopancreatiography (ERCP) was then performed. A total of 532 patients were available for continuous postoperatively follow-up (median 54 months, range 36–85). In 462 patients (247 female, and 215 male), MR images were also reviewed for variants of the cystic duct. In 705 patients (91%), MRC was negative for CBD stones. In 64 patients (9%) MRC was positive. Of these patients, 47 (6%) had CBD stones on ERCP. In 12 patients (2%), MRC was false positive. In five cases (0.6%), ERCP had an inconclusive result postoperative follow-up (532 patients, or 69%) revealed evidence of CBD stones in three patients (10.4%) despite a preoperative negative MRC result. Anatomical variants in the course of the cystic duct and its confluence with the common bile duct were found in 27 of 462 patients (6%). Magnetic resonance cholangiography proved to be a reliable screening technique in the preoperative evaluation of patients with silent CBD stones. Imaging of the course of the cystic duct is possible in a high percentage of cases. Therefore, MRC can be recommended as a screening technique before laparoscopic cholecystectomy. |
| Databáze: | OpenAIRE |
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