Korean J Hepatobiliary Pancreat Surg.
2012 Feb;16(1):17-23. 10.14701/kjhbps.2012.16.1.17.
Relationship between the risk of bile duct injury during laparoscopic cholecystectomy and the types of preoperative magnetic resonance cholangiopancreatiocography (MRCP)
- Affiliations
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- 1Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea. drkdj@hallym.or.kr
- 2Department of Radiology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
- KMID: 1434607
- DOI: http://doi.org/10.14701/kjhbps.2012.16.1.17
Abstract
- BACKGROUNDS/AIMS
Bile duct injury is one of the potential severe complications that can occur during laparoscopic cholecystectomy, which can be cause by anatomic variations in the confluence of the bile duct. Recently magnetic resonance cholangiopancreatiocography (MRCP) has become a helpful tool to detect bile duct variation on a preoperative basis and to prevent bile duct injury during laparoscopic cholecystectomy, as well other hepatic surgeries. This study aimed to clarify the types of bile duct on MRCP and to search for a method of avoiding injury during laparoscopic cholecystectomy.
METHODS
Between January 2009 and December 2010, 277 patients underwent laparoscopic cholecystectomy with preoperative MRCP in our institution. On a retrospective basis, the bile ducts were categorized into 5 types according to the Couinaud classification system.
RESULTS
The proportion of types was revealed type A (70.4%), type B (8.7%), type C (19.5%), type D (0.7%), type E (0%), and type F (0.7%), respectively. Bile duct injury occurred in 4 cases (1.4%) during laparoscopic cholecystectomy. In particular, the possibility of aberrant extrahepatic confluence (Type C and F) represented the highest risk of duct injury (OR=11.89 [CI: 1.21-116.53]).
CONCLUSIONS
Preoperative evaluation of the bile duct anatomy is important to avoid injury of duct during laparoscopic cholecystectomy. Specific types of bile duct variation should be considered as a high risk group for bile duct injury.
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