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Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in
Kojiro Omiya1, Kazuhiro Hiramatsu1, Yoshihisa Shibata1
1Department of General Surgery, Toyohashi Municipal Hospital, 50 Hakken-Nishi, Aotake-Cho, Toyohashi City, Aichi Prefecture 440-8570, Japan.
Abstract:
Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11-13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74-13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.
Insights
Gallbladder wall signal intensity on MRI predicts surgical difficulty in acute cholecystitis. Low signal intensity indicates higher bailout procedure rates and longer operating times during laparoscopic cholecystectomy.
Area of Science:
- Radiology
- Surgical Gastroenterology
Background:
- Gallbladder wall signal intensity on MRI correlates with necrosis and fibrosis in acute cholecystitis (AC).
- The relationship between preoperative MRI findings and operative outcomes in AC is not well-defined.
Purpose of the Study:
- To investigate the association between gallbladder wall signal intensity on preoperative magnetic resonance imaging (MRI) and operative outcomes in patients with acute cholecystitis undergoing laparoscopic cholecystectomy (LC).
Main Methods:
- Retrospective analysis of 321 patients with AC who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and LC.
- Patients were categorized into high (HSI), intermediate (ISI), and low (LSI) signal intensity groups based on gallbladder wall appearance on MRI.
- Bailout procedure rates (open conversion, subtotal LC) and operating times were compared across groups.
Main Results:
- Bailout procedure rates were significantly higher in the LSI group (40.2%) compared to ISI (26.7%) and HSI (6.8%) groups (p < 0.001).
- Median operating times increased progressively from HSI (95 min) to ISI (110 min) and LSI (138 min) groups (p < 0.001).
- Low signal intensity (LSI) on gallbladder wall MRI independently predicted bailout procedures (OR 5.30) and prolonged surgery (OR 6.10).
Conclusions:
- Preoperative MRCP/MRI assessment of gallbladder wall signal intensity can predict surgical difficulty during LC for AC.
- LSI is a significant independent predictor of increased bailout rates and longer operative times.
- This imaging-based approach may aid in surgical planning and patient management for AC.
