Abstract
Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.
Highlights
Acute cholecystitis (AC) is one of the most common surgical emergencies in the world
low signal intensity (LSI) progression of the gallbladder wall in AC was significantly associated with a higher rate of bailout procedures, such as open conversion and laparoscopic subtotal cholecystectomy, and prolonged operating times
Our results indicate that preoperative assessment of the signal intensity of the gallbladder wall on magnetic resonance imaging (MRI) is a novel and useful predictor for surgical difficulty during laparoscopic cholecystectomy (LC) for AC
Summary
Acute cholecystitis (AC) is one of the most common surgical emergencies in the world. Severe intraoperative complications such as bile duct injury occur at a certain rate in LC [2,3]. Given the number of daily surgeries performed, preoperative assessment to prevent intraoperative complications in each case is crucial. Surgical difficulty due to severe inflammation and an anatomical anomaly of the bile duct, such as an aberrant posterior sectoral hepatic duct (PHD), are the most common causes of serious complications, such as bile duct injury, during LC [2,4,5,6]. To determine the appropriate treatment strategy and perform subsequent early LC safely, the surgeon needs the ability to predict the surgical difficulty of LC and assess the biliary anatomy in a limited amount of time before surgery, especially in emergency conditions
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