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Preoperative ultrasonography (US) alone versus combined ultrasonography and magnetic resonance cholangiopancreatography (MRCP) in assessment of patients with cholecystitis and/or gall bladder stones prior to laparoscopic cholecystectomy: Could combined procedure become a routine?
Suez Canal University; Faculty of Medicine • 2011
Publication Information
Authors
Order of Authors: mahmoud A Bahram, MD; Mahmoud Abdel Latif Bahram, MD; Ahmed M Ghandour,MD; Hesham Y Al Gazzar, MD
Keywords
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Journal
Suez Canal University; Faculty of Medicine
Publisher
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Volume
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Pages
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publication.type
Local
Paper Link
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Supplementary Materials
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Abstract
Objective:
To evaluate the value of preoperative combined US and MRCP versus US alone on the
post operative outcome of patients with cholecystitis and/or gall stones.
Patients & methods:
This prospective study was carried on 202 patients during a period of 3 years who were
planned to undergo laparoscopic cholecystectomy. Preoperative combined US and MRCP was
performed in 90 patients included in group I with age range of 20-65 years. Remainder of the study
population (112 patients) were included in group II with preoperative US alone -and without preoperative
MRCP- with age range of 22-64 years.
Results:
In group I; preoperative MRCP screening revealed clinically silent common bile duct (CBD)
stones in 5 patients (5.6%) and mud and gravels in 2 patients (2.2%). Accessory cystic duct in 2
patients (2.2%), abnormal insertion of cystic duct in 2 patients (2.2%), trifurcation of the common
hepatic duct (CHD) in 1 patient (1.1%), long serpentine cystic duct in 1 patient (1.1%), and pancreas
divisum in another patient (1.1%). Postoperatively, in group I no residual CBD stones were
revealed. On the other hand 6 patients with residual stones were detected in group II,
Conclusion
Combined MRCP and US procedure has proved to be a very useful tool in assessment of patients with
cholecystitis and/or gall bladder stones prior to laparoscopic cholecystectomy in comparison to US
alone, taking advantage of the high sensitivity and excellent negative test -negative predictive value- of
MRCP. The use of the combined procedure has been justified in terms of cost/benefit relationship.
Therefore, we recommend the combined procedure to be part of the routine workup before
laparoscopic cholecystectomy in patients with cholecystitis and/or gall bladder stones.
To evaluate the value of preoperative combined US and MRCP versus US alone on the
post operative outcome of patients with cholecystitis and/or gall stones.
Patients & methods:
This prospective study was carried on 202 patients during a period of 3 years who were
planned to undergo laparoscopic cholecystectomy. Preoperative combined US and MRCP was
performed in 90 patients included in group I with age range of 20-65 years. Remainder of the study
population (112 patients) were included in group II with preoperative US alone -and without preoperative
MRCP- with age range of 22-64 years.
Results:
In group I; preoperative MRCP screening revealed clinically silent common bile duct (CBD)
stones in 5 patients (5.6%) and mud and gravels in 2 patients (2.2%). Accessory cystic duct in 2
patients (2.2%), abnormal insertion of cystic duct in 2 patients (2.2%), trifurcation of the common
hepatic duct (CHD) in 1 patient (1.1%), long serpentine cystic duct in 1 patient (1.1%), and pancreas
divisum in another patient (1.1%). Postoperatively, in group I no residual CBD stones were
revealed. On the other hand 6 patients with residual stones were detected in group II,
Conclusion
Combined MRCP and US procedure has proved to be a very useful tool in assessment of patients with
cholecystitis and/or gall bladder stones prior to laparoscopic cholecystectomy in comparison to US
alone, taking advantage of the high sensitivity and excellent negative test -negative predictive value- of
MRCP. The use of the combined procedure has been justified in terms of cost/benefit relationship.
Therefore, we recommend the combined procedure to be part of the routine workup before
laparoscopic cholecystectomy in patients with cholecystitis and/or gall bladder stones.