Does preoperative magnetic resonant cholangiopancreatography (MRCP), improve the safety of laparoscopic cholecystectomy?

"Evaluation of hepatobiliary disorders using magnetic resonance cholangiopancreatography in a low-resource setting in Kano, Nigeria: a retrospective study"

BACKGROUND

Biliary disorders are a major health concern in Nigeria, where magnetic resonance cholangiopancreatography (MRCP), a non-invasive imaging tool offering effective duct visualization without radiation, is emerging as a key diagnostic modality. This retrospective study in Kano explored its role in diagnosing biliary and pancreatic disorders.

MATERIALS AND METHODS

This retrospective study reviewed MRCP images and records of patients with suspected biliary disorders at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. A 1.5T magnetic resonance imaging (MRI) machine obtained MRCPs following standard protocols, and key findings (e.g., calculus size and masses) were documented. Demographic and clinical data were analyzed in IBM-Statistical Package for Social Sciences (SPSS), with p<0.05 considered significant. Ethical approval was obtained, and patient confidentiality was upheld.

RESULTS

A study of 101 participants (mean age: 44 ± 19.41 years, range: 3 months to 80 years) revealed a male predominance (55.4%). Obstructive jaundice (46.5%) was the most common MRCP indication, with imaging abnormalities observed in 84.2%, primarily obstructive cholelithiasis (22.8%) and pancreatic head masses (13.9%).

CONCLUSION

MRCP successfully detected hepatobiliary and pancreatic abnormalities in most patients, with obstructive jaundice being the primary indication and obstructive cholelithiasis the most frequent diagnosis. The study also found a correlation between main pancreatic duct diameter and age, where larger diameters signalled abnormalities, reinforcing MRCP's diagnostic significance.

Congenital absence of the cystic duct: Case report of a rare anomaly and review of the literature

INTRODUCTION AND IMPORTANCE

Congenital absence of the cystic duct is one of the rare types of anomalies associated with the extrahepatic biliary tract (EHBT). It is often an incidental finding intraoperatively leading to significant implications during the perioperative period.

CASE PRESENTATION

A 25-year-old lady was admitted for an elective laparoscopic cholecystectomy indicated for recurrent symptoms of right upper quadrant pain with evidence of cholelithiasis on ultrasound. During laparoscopy, the cystic duct could not be identified. After retrieval of the gallbladder, a blind ending orifice resembling an obliterated cystic duct was discovered.

CLINICAL DISCUSSION

Absence of the cystic duct can result from a congenital or an acquired process. In both cases, they are difficult to diagnose pre-operatively even though magnetic resonance cholangiopancreatography (MRCP) has shown great potential in delineating the EHBT. It confers an increased risk of injury to the surrounding biliary tract during cholecystectomy. Therefore, the surgical approach depends on the surgeon's operative competency and knowledge related to EHBT anomalies.

CONCLUSION

Definitive treatment for patients with symptomatic absent cystic duct is an open cholecystectomy, given its increased likelihood of iatrogenic morbidity. Nonetheless, it is important to highlight that laparoscopic cholecystectomy may be performed if the surgeon carries sufficient skills.

The Status and Development of Oral Choledochoscopy Diagnosis and Treatment of Biliary Tract Diseases

Choledochoscopy technology has realized the direct observation of bile duct lesions, and can be loaded with a variety of special accessories to perform the corresponding diagnosis and treatment operations, and has become an important means for the diagnosis of unexplained bile duct stricture and treatment of refractory bile duct stones. With the further enhancement of the imaging quality and operability, the clinical application of choledochoscopy has gradually expanded to the precise positioning of cholangiocarcinoma before surgical resection, the drainage of the gallbladder through the nipple, the removal of the displaced bile duct stent and other fields. This paper briefly reviewed the historical evolution of choledochoscopy and reviewed the latest clinical advances of oral choledochoscopy in the diagnosis and treatment of biliary tract diseases.