Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging – A case series

Platt, Timothy; Smith, Kristy; Nixon, Martha; Sinha, Surajit; Srinivas, Gandrapu; Andrews, Stuart

doi:10.1016/j.amsu.2018.10.036

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…It is reported that 10% ~ 20% of patients with cholecystolithiasis coexist with CBDS [ 15 ]. If the presence of CBDS can be determined before LC, the incidence of postoperative residual CBDS can be reduced [ 16 ]. The incidence of LC bile duct injury is 0.2–1.1% [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Guo,

Fan,

Guo

et al. 2024

BMC Gastroenterol

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Background In the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis. Methods According to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups. Results Among the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05). Conclusions The preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.

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Section: Discussionmentioning

confidence: 99%

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Guo,

Fan,

Guo

et al. 2024

BMC Gastroenterol

View full text Add to dashboard Cite

show abstract

“…It is reported that 10% ~ 20% of patients with cholecystolithiasis coexist with CBDS [13]. If the presence of CBDS can be determined before LC, the incidence of postoperative residual CBDS can be reduced [14]. The incidence of LC bile duct injury is 0.2-1.1% [15].…”

Section: Discussionmentioning

confidence: 99%

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Guo,

Fan,

Guo

et al. 2023

Preprint

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Background: In the past quite a long time, intraoperative cholangiography（IOC）was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patientsundergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis. Methods: According to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups. Results: Among the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCPwere higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05). Conclusions: The preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.

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“…Different approaches have been advocated in the management of CBD stones from laparoscopic single-stage CBD clearance (LCBDC) to single- and dual-stage LCBDC with intraoperative ERCP [ 66 , 67 ]. In their meta-analysis, Pan and colleagues found that LCBDC during laparoscopic cholecystectomy (LC) has superior outcomes to a preoperative ERCP sphincterotomy followed by LC and should be considered as the optimal treatment choice for CBD stones [ 67 ].…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

Donnellan

Coulter

Mathew

et al. 2021

Surgery Open Science

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Background Despite some evidence of improved survival with intraoperative cholangiography during cholecystectomy, debate has raged about its benefit, in part because of its questionable benefit, time, and resources required to complete. Methods An International Prospective Register of Systematic Reviews–registered (ID CRD42018102154) meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Scopus, Web of Science, and Cochrane library from 2003 to 2018 was undertaken including search strategy “intraoperative AND cholangiogra* AND cholecystectomy.” Articles scoring ≥ 16 for comparative and ≥ 10 for noncomparative using the Methodological Index for Non-Randomized Studies criteria were included. A dichotomous random effects meta-analysis using the Mantel-Haenszel method performed on Review Manager Version 5.3 was carried out. Results Of 2,059 articles reviewed, 62 met criteria for final analysis. The mean rate of intraoperative cholangiography was 38.8% (range 1.6%–96.4%).There was greater detection of bile duct stones during cholecystectomy with routine intraoperative cholangiography compared with selective intraoperative cholangiography (odds ratio = 3.28, confidence interval = 2.80–3.86, P value < .001). While bile duct injury during cholecystectomy was less with intraoperative cholangiography (0.39%) than without intraoperative cholangiography (0.43%), it was not statistically significant (odds ratio = 0.88, confidence interval = 0.65–1.19, P value = .41). Readmission following cholecystectomy with intraoperative cholangiography was 3.0% compared to 3.5% without intraoperative cholangiography (odds ratio = 0.91, confidence interval = 0.78–1.06, P value = .23). Conclusion The use of intraoperative cholangiography still has its place in cholecystectomy based on the detection of choledocholithiasis and the potential reduction of unfavorable outcomes associated with common bile duct stones. This meta-analysis, the first to review intraoperative cholangiography use, identified a marked variation in cholangiography use. Retrospective studies limit the ability to critically define association between intraoperative cholangiography use and bile duct injury.

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Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging – A case series

Cited by 6 publications

References 30 publications

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

Clinical study on the necessity and feasibility of routine MRCP in patients with cholecystolithiasis before LC

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

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