scholarly journals Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

2017 ◽  
Vol 4 (11) ◽  
pp. 3633 ◽  
Author(s):  
Ganni Bhaskara Rao ◽  
Samir Ranjan Nayak ◽  
Sepuri Bala Ravi Teja ◽  
Reshma Palacharla
Keyword(s):  
Patient Safety ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Liver Function Test ◽  
Ultrasound Examination ◽  
Cbd Stones ◽  
Function Test ◽  
Cbd Stone

Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

Usefulness of early post-operative liver function test monitoring after laparoscopic common bile duct exploration

2015 ◽  
Vol 87 (11) ◽  
pp. 925-929
Author(s):  
Chandika Wewelwala ◽  
Paul Cashin ◽  
Roger Berry ◽  
Stephen Blamey ◽  
Gregory E. Jones ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Liver Function Test ◽  
Common Bile Duct Exploration ◽  
Function Test

Case 17.21

2014 ◽  
pp. 829-830
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Ulcerative Colitis ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Liver Function Test ◽  
Test Results ◽  
Left Hepatic Lobe ◽  
Hepatic Lobe ◽  
Function Test ◽  
The Common

23-year-old man with ulcerative colitis and elevated liver function test results MIP images from 3D FRFSE MRCP (Figure 17.21.1) demonstrate focal stricture of the common bile duct at its bifurcation in the hepatic hilum. Focal beading of a mildly prominent duct in the left hepatic lobe is also noted. Axial fat-suppressed 2D SSFP images (...

scholarly journals Evaluation of effect of cholecystectomy on common bile duct diameter using ultrasonography and liver function test: a prospective study

2018 ◽  
Vol 5 (4) ◽  
pp. 1323
Author(s):  
Shreyas Bhalerao Shreyas Bhalerao ◽  
Pooja Batra ◽  
Maneshwar Singh Utaal ◽  
Chirag Sasan
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Liver Function Test ◽  
Imaging Method ◽  
Duct Diameter ◽  
Function Test ◽  
The Difference ◽  
Common Bile Duct Diameter

Background:Different factors influencing the post cholecystectomy CBD diameter have been implicated. Ultrasound has emerged as a diagnostic imaging method of choice for liver and extrahepatic biliary system. In order to differentiate the diagnosis of asymptomatic bile duct dilatation, one needs to perform either MRCP or ERCP, which are both expensive and/or invasive test. Therefore, it is necessary to understand the physiological changes in bile duct after cholecystectomy to reduce unnecessary testing for early detection of bile duct lesions.Methods: 100 cases of gall stone disease undergoing cholecystectomy in the department of surgery were studied. Pre operative and Post operative Ultrasound whole abdomen with focus on CBD diameter and Liver function test were done, Post operative data was collected on 10th day and again after 3 months. The data was compiled, compared and analysed.Results:The mean preoperative diameter was 4.12 mm, postoperatively, the mean diameter of the CBD in early follow up period i.e. at 10th day and at 3 months, was found to be 4.75 and 5.14 mm respectively. The difference between mean preoperative and mean postoperative (10th day follow up) diameter was found to be 0.63 mm (p<0.01). The difference between mean preoperative and mean postoperative (3 months follow up) diameter was found to be 1.02 (p<0.01) mm, both statistically significant. Conclusions:Significant compensatory dilatation does occur in common bile duct diameter after cholecystectomy in most of the patients.

scholarly journals Laparoscopic Common Bile Duct Exploration for Choledocholithiasis During a Pregnancy: a Case Report

2016 ◽  
Vol 16 (1) ◽  
pp. 41-43 ◽  
Author(s):  
Janis Lacis ◽  
Ieva Rancane ◽  
Haralds Plaudis ◽  
Evita Saukane ◽  
Guntars Pupelis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Disease ◽  
Intraoperative Ultrasound ◽  
Common Bile Duct Exploration ◽  
Dynamic Imaging ◽  
Gallbladder Motility ◽  
Cbd Stones ◽  
Nulliparous Women

SummaryIn population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to 19.3% of women with two to three or more pregnancies (7). Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies. Pregnancy induced physiological hormonal changes are associated with a decrease of gallbladder motility and increased cholesterol saturation of bile, leading to biliary stone formation (12,6,8). Surgical approach nowadays is the method of choice in the management of symptomatic gallstone disease during pregnancy, preferably if possible surgery should be postponed to second trimester (7,8).Preoperative radiologic imaging using magnetic resonance cholangiopancreatography is the golden standard for patients with suspected choledocholithiasis, however, its application during pregnancy is limited (9). Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be used before, during or after laparoscopic cholecystectomy when it is indicated, but unfortunately, its application during pregnancy is associated with considerable number of complications concerning mother and fetus. Alternative approach has been developed and recommended for patients with the common bile duct (CBD) stones providing laparoscopic common bile duct exploration (LCBDE). Intraoperative cholangiography or intraoperative ultrasound (IOUS) are the methods currently used for detection of the CBD stones during laparoscopic cholecystectomy, however, IOUS can be considered as the method of choice during pregnancy (3).IOUS is a dynamic imaging modality that provides interactive and timely information during surgical procedures. Because the transducer is in direct contact with the organ being examined, high-resolution images can be obtained that are not degraded by air, bone, or overlying soft tissue (1).

scholarly journals P-BN39 The perils of MRCP requesting and early associations of data quality and likelihood of a diagnostic result

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Callum Jones ◽  
Helena Barton ◽  
Samir Pathak ◽  
Jonathan Rees
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Expectant Management ◽  
Clinical Information ◽  
Common Bile Duct Stones ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Tree ◽  
Cbd Stones ◽  
Optimal Information ◽  
Cbd Stone

Abstract Background MRCP (Magnetic resonance cholangiopancreatography) is used most to assess the biliary tree for stones or strictures. Recently, MRCP availability has increased, and it is extensively used to detect of common bile duct (CBD)stones although very frequently no stones are seen. Indeed, the currently recruiting sunflower RCT aims to determine the clinical and cost effectiveness of expectant management versus MRCP in patients undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. However, it is critical when requesting an investigation that adequate information is provided.  This work aimed, to describe the adequacy of information provided and correlate this with the MRCP result. We hypothesised that the less information that was provided the more common a normal result would be. Methods For a three month period (January 2021 to April 2021) all MRCP requests to detect the presence of a CBD stone were reviewed and data obtained from the Radiology CRIS (CDN Radiology Information System, CDN, Sydney, Aus.). The requesting information was compared to three pre-defined criteria (CBD diameter, presence of gallstones and LFT details) that were agreed as the optimal information that a reporting radiologist would require. The number of key pieces of information for each request and whether the request identified a CBD stone were identified. The proportion of MRCPs detecting a CBD stone was calculated according to the number of key pieces of information provided.     Results 56 patients were identified, of which 16 (29%) patients had CBD stones. In 24/56 (43%) patients the presence of gallstones on a previous ultrasound was provided, 14/56 (25%) of patients had information about LFTs including bilirubin and a trend in LFTs was not stated for any patient (0/56; 0%).  The rate of stone detection was calculated by the number of pieces of information provided. The rate was 71% (5/7) when all 3 pieces of data were provided, 31% (2/13) when two piece of information were provided, 30% (8/27) when a single piece of information was provided, and only 11% (1/11) when none of the specified data were provided. Conclusions It is uncommon for adequate clinical information to be provided in MRCP requests and in 16% of request no key information was provided. The LFT results were frequently omitted and the trend in LFTs never stated. The more key data provided in the request saw a higher proportion of MRCPs where a CBD stone was identified. We recommend that maximal clinical information is mandated for MRCP request perhaps using mandatory fields on electronic requesting systems and that  these systems are also used to facilitate recruitment to clinical trials such the Sunflower RCT.

scholarly journals Increased Prevalence of Subclinical Hypothyroidism in Common Bile Duct Stone Patients

2007 ◽  
Vol 92 (11) ◽  
pp. 4260-4264 ◽  
Author(s):  
Johanna Laukkarinen ◽  
Gediminas Kiudelis ◽  
Marko Lempinen ◽  
Sari Räty ◽  
Hanna Pelli ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Subclinical Hypothyroidism ◽  
Sphincter Of Oddi ◽  
Liver Function Tests ◽  
Control Group ◽  
Cbd Stones ◽  
History Of ◽  
Cbd Stone ◽  
Previous Medical History

Abstract Context: Earlier, we have shown an increased prevalence of previously diagnosed hypothyroidism in common bile duct (CBD) stone patients and a delayed emptying of the biliary tract in hypothyroidism, explained partly by the missing prorelaxing effect of T4 on the sphincter of Oddi contractility. Objective: In this study, the prevalence of previously undiagnosed subclinical hypothyroidism in CBD stone patients was compared with nongallstone controls. Patients: All patients were clinically euthyreotic and without a history of thyroid function abnormalities. CBD stones were diagnosed at endoscopic retrograde cholangiopancreatography (group 1; n = 303) or ruled out by previous medical history, liver function tests, and ultrasonography (control group II; n = 142). Main Outcome Measures: Serum free FT4 and TSH (S-TSH) were analyzed; S-TSH above the normal range (&gt;6.0 mU/liter) was considered as subclinical and S-TSH 5.0–6.0 mU/liter as borderline-subclinical hypothyroidism. Results: A total of 5.3 and 5.0% (total 10.2%; 31 of 303) of the CBD stone patients were diagnosed to have subclinical and borderline-subclinical hypothyroidism, compared with 1.4% (P = 0.05) and 1.4% (total 2.8%, four of 142; P = 0.026) in the control group, respectively. In women older than 60 yr, the prevalence of subclinical hypothyroidism was 11.4% in CBD stone and 1.8% in control patients (P = 0.032) and subclinical plus borderline-subclinical hypothyroidism 23.8% in CBD stone and 1.8% in control patients (P = 0.012). Conclusion: Subclinical hypothyroidism is more common in the CBD stone patients, compared with nongallstone controls, supporting our hypothesis that hypothyroidism might play a role in the forming of CBD stones. At minimum, women older than 60 yr with CBD stones should be screened for borderline or overt subclinical hypothyroidism.

scholarly journals Routine intraoperative cholangiography during laparoscopic cholecystectomy: application of the 2016 WSES guidelines for predicting choledocholithiasis

2021 ◽  
Author(s):  
Hui-Ying Lai ◽  
Kuei-Yen Tsai ◽  
Hsin-An Chen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Risk Groups ◽  
Intraoperative Cholangiography ◽  
Uneventful Recovery ◽  
Gallstone Pancreatitis ◽  
Cbd Stones ◽  
Study Results ◽  
Wses Guidelines

Abstract Background Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) for detecting common bile duct stones remains controversial. The 2016 World Society of Emergency Surgery (WSES) guidelines on acute calculous cholecystitis proposed a risk stratification for choledocholithiasis. Our present study aimed to (1) examine the findings of common bile duct (CBD) stones in patients underwent LC with routine use of IOC, and (2) validate the 2016 WSES risk classes for predicting choledocholithiasis. Methods All patients had LC with IOC routinely performed from November 2012 to December 2017 were reviewed retrospectively. Patients were classified into high-, intermediate-, and low-risk groups based on the 2016 WSES risk classes with modification. Results A total of 990 patients with LC and routine IOC were enrolled. CBD stones were detected in 197 (19.9%) patients. The rate of CBD stone detected in low-, intermediate-, high-risk groups were 0%, 14.2%, and 89.6%, respectively. Predictors as following: evidence of CBD stones on abdominal ultrasound or computed tomography, CBD diameter > 6 mm, total bilirubin > 4 mg/dL, bilirubin level = 1.8–4 mg/dL, abnormal liver biochemical test result other than bilirubin, presence of clinical gallstone pancreatitis had statistical significance between patients with and without CBD stones. Major bile duct injury was found in 4 patients (0.4%). All 4 patients had uneventful recovery after repair surgery. Conclusions Based on our study results, the 2016 WSES risk classes for choledocholithiasis could be an effective approach for predicting the risk of choledocholithiasis. Considering its advantages for detecting CBD stones and biliary injuries, the routine use of IOC is still suggested.

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