[Clinical relevance of a routinely performed magnetic resonance cholangiopancreatography (MRCP) prior to cholecystectomy].

Abstract

BACKGROUND:

A preoperative diagnostic imaging procedure is essential for therapy in cholecystolithiasis. According to the S3-Guidelines of the German Society for General and Visceral Surgery only an ultrasound scan is needed before a cholecystectomy. But an anatomic variant of the bile ducts or choledocholithiasis is poorly shown by an ultrasound. Because of this, we performed a magnetic resonance cholangiopancreatography (MRCP) routinely. This study was designed to show if the MRCP changed the treatment plan or changed the operation method. Furthermore, the sensitivity and specificity concerning abnormalities of the cystic duct, accessory bile ducts and choledocholithiasis should be determined.

PATIENTS AND METHODS:

During the time between January 1st 2005 and September 30th 2009 541 patients were included in this retrospective study.

RESULTS:

Among the 541 cases 98 pathologies were found. These included 51 choledocholithiasis, 20 accessory bile ducts and 13 abnormal cystic ducts. In 29 of the 51 cases of choledocholithiasis a therapeutic splitting was performed only because of the MRCP. In 22 cases the diagnosis was also possible because of the basic diagnostic procedures like ultrasound, laboratory tests and clinical appearance. So the diagnostic aimprovement due to the MRCP is 5.3 %. Four of the 20 accessory bile ducts and 6 of the abnormal cystic ducts were found during the subsequent operation. The sensitivity concerning the anatomic variants is very low (38.5 % concerning the accessory bile ducts and 50 % for the abnormal cystic ducts). But the sensitivity in detecting a choledocholithiasis is very high (94.7 %). There was no evidence in our study that MRCP prevented any complications. The operation method was not changed in any case because of the MRCP result.

CONCLUSION:

A routinely performed preoperative MRCP cannot be recommended.

• Authors: R Schmidt, M Tannheimer, B Danz, S Benesch, R Geue
• Journal: Zentralblatt fur Chirurgie (Zentralbl Chir) Vol. 137 Issue 6 Pg. 541-8 (Dec 2012) ISSN: 1438-9592 [Electronic] Germany
• Vernacular Title: Klinische Wertigkeit einer routinemäßigen Magnetresonanz-Cholangiopankreatikografie (MRCP) vor Cholezystektomie.
• PMID: 22388647 (Publication Type: English Abstract, Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Topics

• Bile Ducts, Extrahepatic (abnormalities, pathology, surgery)
• Cholangiopancreatography, Magnetic Resonance (methods)
• Cholecystectomy (methods)
• Cystic Duct (abnormalities, pathology, surgery)
• Gallbladder (blood supply, pathology, surgery)
• Gallstones (diagnosis, pathology, surgery)
• Guideline Adherence
• Humans
• Preoperative Care
• Retrospective Studies
• Sensitivity and Specificity
• Ultrasonography
• Veins (abnormalities, pathology, surgery)