Prof. Hisham Youssef Ibrahim Algazar :: Publications:

Objective: To evaluate the value of preoperative combined US and MRCP versus US alone on the post operative outcome of patients with cholecystitis and/or gall stones. Patients & methods: This prospective study was carried on 202 patients during a period of 3 years who were planned to undergo laparoscopic cholecystectomy. Preoperative combined US and MRCP was performed in 90 patients included in group I with age range of 20-65 years. Remainder of the study population (112 patients) were included in group II with preoperative US alone -and without preoperative MRCP- with age range of 22-64 years. Results: In group I; preoperative MRCP screening revealed clinically silent common bile duct (CBD) stones in 5 patients (5.6%) and mud and gravels in 2 patients (2.2%). Accessory cystic duct in 2 patients (2.2%), abnormal insertion of cystic duct in 2 patients (2.2%), trifurcation of the common hepatic duct (CHD) in 1 patient (1.1%), long serpentine cystic duct in 1 patient (1.1%), and pancreas divisum in another patient (1.1%). Postoperatively, in group I no residual CBD stones were revealed. On the other hand 6 patients with residual stones were detected in group II, Conclusion Combined MRCP and US procedure has proved to be a very useful tool in assessment of patients with cholecystitis and/or gall bladder stones prior to laparoscopic cholecystectomy in comparison to US alone, taking advantage of the high sensitivity and excellent negative test -negative predictive value- of MRCP. The use of the combined procedure has been justified in terms of cost/benefit relationship. Therefore, we recommend the combined procedure to be part of the routine workup before laparoscopic cholecystectomy in patients with cholecystitis and/or gall bladder stones.