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
  • 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.

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.

Keyword

Bile duct; Magnetic resonance cholangiopancreatiocography; Cholecystectomy

MeSH Terms

Bile
Bile Ducts
Cholecystectomy
Cholecystectomy, Laparoscopic
Humans
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Retrospective Studies

Reference

1. Lee VS, Morgan GR, Teperman LW, et al. MR imaging as the sole preoperative imaging modality for right hepatectomy: a prospective study of living adult-to-adult liver donor candidates. AJR Am J Roentgenol. 2001. 176:1475–1482.
2. Ayuso JR, Ayuso C, Bombuy E, et al. Preoperative evaluation of biliary anatomy in adult live liver donors with volumetric mangafodipir trisodium enhanced magnetic resonance cholangiography. Liver Transpl. 2004. 10:1391–1397.
3. Basaran C, Agildere AM, Donmez FY, et al. MR cholangiopancreatography with T2-weighted prospective acquisition correction turbo spin-echo sequence of the biliary anatomy of potential living liver transplant donors. AJR Am J Roentgenol. 2008. 190:1527–1533.
4. Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg. 1997. 184:571–578.
5. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001. 234:549–558.
6. Taourel P, Bret PM, Reinhold C, Barkun AN, Atri M. Anatomic variants of the biliary tree: diagnosis with MR cholangiopancreatography. Radiology. 1996. 199:521–527.
7. Kapoor V, Peterson MS, Baron RL, Patel S, Eghtesad B, Fung JJ. Intrahepatic biliary anatomy of living adult liver donors: correlation of mangafodipir trisodium-enhanced MR cholangiography and intraoperative cholangiography. AJR Am J Roentgenol. 2002. 179:1281–1286.
8. Couinaud C, Le foi . Etudes anatomogiques et chirugicales. 1957.
9. Blumgart LH. . Surgery of the Liver, Biliary Tract and Pancreas. 2007. 4th ed. 2-Volume Set with CD-ROM.
10. Puente SG, Bannura GC. Radiological anatomy of the biliary tract: variations and congenital abnormalities. World J Surg. 1983. 7:271–276.
11. Russell E, Yrizzary JM, Montalvo BM, Guerra JJ Jr, al-Refai F. Left hepatic duct anatomy: implications. Radiology. 1990. 174:353–356.
12. Karakas HM, Celik T, Alicioglu B. Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited. Surg Radiol Anat. 2008. 30:539–545.
13. Ran S, Wen TF, Yan LN, et al. Risks faced by donors of right lobe for living donor liver transplantation. Hepatobiliary Pancreat Dis Int. 2009. 8:581–585.
14. An SK, Lee JM, Suh KS, et al. Gadobenate dimeglumine-enhanced liver MRI as the sole preoperative imaging technique: a prospective study of living liver donors. AJR Am J Roentgenol. 2006. 187:1223–1233.
15. The Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med. 1991. 324:1073–1078.
16. Walker AT, Brooks DC, Tumeh SS, Braver JM. Bile duct disruption after laparoscopic cholecystectomy. Semin Ultrasound CT MR. 1993. 14:346–355.
17. Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003. 237:460–469.
18. Andrén-Sandberg A, Johansson S, Bengmark S. Accidental lesions of the common bile duct at cholecystectomy. II. Results of treatment. Ann Surg. 1985. 201:452–455.
19. MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc. 1998. 12:315–321.
20. Hugh TB. New strategies to prevent laparoscopic bile duct injury-surgeons can learn from pilots. Surgery. 2002. 132:826–835.
21. Huang TL, Cheng YF, Chen CL, Chen TY, Lee TY. Variants of the bile ducts: clinical application in the potential donor of living-related hepatic transplantation. Transplant Proc. 1996. 28:1669–1670.
22. Ohkubo M, Nagino M, Kamiya J, et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg. 2004. 239:82–86.
23. Uchiyama K, Tani M, Kawai M, Ueno M, Hama T, Yamaue H. Preoperative evaluation of the extrahepatic bile duct structure for laparoscopic cholecystectomy. Surg Endosc. 2006. 20:1119–1123.
24. Seibert D, Matulis SR, Griswold F. A rare right hepatic duct anatomical variant discovered after laparoscopic bile duct transection. Surg Laparosc Endosc. 1996. 6:61–64.
25. Suhocki PV, Meyers WC. Injury to aberrant bile ducts during cholecystectomy: a common cause of diagnostic error and treatment delay. AJR Am J Roentgenol. 1999. 172:955–959.
26. Kwon SW, Yoon DS, Chi HS. Bile duct injury during laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 1998. 2:111–116.
27. Lillemoe KD, Melton GB, Cameron JL, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg. 2000. 232:430–441.
28. Lee HJ, Hwang S, Lee SG, Song GW, Lee YJ, Kim KH. Treatments of proximal bile duct necrosis and stricture from iatrogenic bile duct injury of laparoscopic cholecystectomy. Korean J Hepatobiliary Pancreat Surg. 2005. 9:156–163.
Full Text Links
  • KJHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr