Abstract
Aim: To evaluate the role of preoperative magnetic resonance cholangiopancreatography (MRCP) in detection of common bile duct stone (CBDS) in cases of gall stone disease (GSD).Methods: This is a retrospective study with a prospectively maintained database, carried out in 116 patients who underwent laparoscopic cholecystectomy (LC) for GSD, from October 2017 to September 2020. Preoperative MRCP was performed in all cases.Results: MRCP detected CBDS in 23 out of 116 patients (19.8%) including silent CBDS in seven patients (6%). In situations of normal biochemical parameters and USG abdomen, 30.4% unnoticed CBDS out of all 23 CBDS, were discovered by MRCP. The sensitivity and specificity of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) [positive predictive value (PPV): 24%; negative predictive value (NPV): 81.3%], alkaline phosphatase (ALP) (PPV: 63.2%; NPV: 88.7%), serum total bilirubin (PPV: 57.1%; NPV: 88.4%) and CBD diameter (PPV: 61.5%; NPV: 85.4%) were, respectively, 26.1% and 79.6%, 52.2% and 92.5%, 52.2% and 90.3%, and 34.8% and 94.6%. Cystic duct variations found in nine patients (7.75%). There was no bile duct injury (0%) noted in post operative patients.Conclusion: With normal biochemical and USG parameters, MRCP is a valuable non-invasive investigation to detect the overlooked CBDS. After recognising the cystic duct variants, it may be possible to prevent bile duct injury. Before performing a laparoscopic cholecystectomy (LC) in GSD, a routine preoperative MRCP is highly recommended.
Highlights
Gall stone disease (GSD) is one of the most common surgical problems in the world
Patients diagnosed with common bile duct stone (CBDS) were subjected to preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)
In the above-mentioned period, 116 patients had undergone for cholecystectomy for GSD
Summary
Gall stone disease (GSD) is one of the most common surgical problems in the world. Laparoscopic cholecystectomy (LC) has become the gold standard procedure for the treatment of gallstones [1]. During treatment, common bile duct (CBD) stones (CBDS) are often overlooked. CBDS are detected in 11%-25% of patients with gall bladder (GB) stones [2,3]. The main preoperative approaches for diagnosing patients with gallstones are medical history, clinical examination, liver function tests (LFTs), and abdominal ultrasonography (USG). This method, does not provide a reliable and precise diagnosis of CBDS [5,6,7]. The accuracy and sensitivity of elevated liver enzymes and abdominal USG in the diagnosis of CBDS associated with GB stone are not high [8,9]. The distal part of CBD and ampulla of Vater is generally the most difficult location to observe due to intestinal gas, making identification of distal CBDS challenging [10]
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