A Study of Anatomical Variations of Extrahepatic Biliary System by Pre-operative Magnetic Resonance Cholangio-Pancreatography and that Encountered during Laparoscopic Cholecystectomy: A Prospective Observational Study

Abstract

Introduction: The variations in cystic duct anatomy are of considerable importance during surgical excision of the gallbladder (cholecystectomy). Preoperative MRCP assessment of possible anatomical variations helps the surgeon to formulate appropriate strategies and operative planning. Objective: To assess the usefulness of pre-operative MRCP assessment of anatomical variations of extra-hepatic biliary tree in surgical planning and validate the MRCP findings with surgical findings. Material and Method: A total 120 patients of ultrasonography proven gallstone disease were included in the study, further evaluated preoperatively by magnetic resonance cholangio-pancreatography for delineation of extra-hepatic biliary anatomy and that was compared with findings during Laparoscopic Cholecystectomy performed in the same patients. Seven patients had frozen Calot’s triangle per-operatively and were excluded from the study. Results: Majority of patients was in age group of 51-60 years (28.4%) and females (85.84%). on MRCP, Posterior insertion of Cystic duct was noted in 58.41% patients, Lateral insertion in 35.39% patients while on per-operatively Posterior insertion was noted in 50.44% and lateral insertion in 38.94 % patients. Most common intra-op complication was Bile spill in 19.4% patients, Stone spill in 9.7% patients and there was no bile duct injury noted. Conclusion: There is a definitive role of magnetic resonance cholangio-pancreatography prior to laparoscopic cholecystectomy in gallstone disease for precisely delineating the extra hepatic biliary tree anatomy and predicting difficult surgery thus helping the surgeon to be prepared for the eventualities during surgery and to prevent biliary injury. However still intra-op picture can vary and overall, there is reduction in patient morbidity.