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Objective:
To assess the frequency of anatomical variations of pancreatic duct through magnetic resonance cholangiography pancreatography. .
Methods:
The cross-sectional prospective study was conducted from May 2011 to December 2012 at the Department of Anatomy, Institute of Basic Medical Sciences (IBMS), Dow University of Health Sciences, Karac...
Contexts in source publication
Context 1
... majority of individuals, the union of these structures allows for a fusion of their ductal systems such that the main pancreatic duct (MPD) serves as the path for emptying of pancreatic secretions into the duodenum via the major duodenal papilla. A normal variant anatomy is present in approximately 30% individuals, where the proximal dorsal pancreatic duct (DPD) persists as an accessory pancreatic duct and empties via the minor duodenal papilla (Figure 1). 4 The frequency of anatomical variation and congenital anomalies in pancreatobiliary tract are 57.7% and 42.3% in the general population, with females being more prone to variations compared to the males. ...
Context 2
... majority of individuals, the union of these structures allows for a fusion of their ductal systems such that the main pancreatic duct (MPD) serves as the path for emptying of pancreatic secretions into the duodenum via the major duodenal papilla. A normal variant anatomy is present in approximately 30% individuals, where the proximal dorsal pancreatic duct (DPD) persists as an accessory pancreatic duct and empties via the minor duodenal papilla (Figure 1). 4 The frequency of anatomical variation and congenital anomalies in pancreatobiliary tract are 57.7% and 42.3% in the general population, with females being more prone to variations compared to the males. ...
Citations
... In addition, MRCP before LC is also helpful for the diagnosis of pancreatitis and biliopancreatic tumors [30,31]. In our study, there were 3 patients with biliary colic in the MRCP group. ...
Background
In the past quite a long time, intraoperative cholangiography(IOC)was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patients undergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis.
Methods
According to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups.
Results
Among the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05).
Conclusions
The preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.
... In addition, MRCP before LC is useful for the diagnosis of pancreatitis and biliopancreatic tumors. The sensitivity and speci city of MRCP in the diagnosis of early pancreatic head cancer, cholangiocarcinoma and other biliary obstruction are greater than 90% [33,34]. In our study, 3 patients in the experimental group developed biliary colic. ...
Objective
To demonstrate if patients with cholecystolithiasis at low risk of common bile duct stones (CBDS) require magnetic resonance cholangiopancreatography (MRCP) before laparoscopic cholecystectomy (LC). This study investigated the clinical value of routine MRCP before LC in patients with gallstones.
Methods
We adopted a non-randomized controlled experiment according to whether MRCP performed prior to LC, 277 patients with cholecystolithiasis at low risk of CBDS were divided into two groups:142 patients in the control group only underwent abdominal ultrasound, while 135 patients in the experimental group underwent both abdominal ultrasound and MRCP. The results of laboratory test, abdominal ultrasound and MRCP, surgical complications, length of stay and hospitalization costs were compared between the two groups.
Result
The detection rates of CBDS, cystic duct stones, gallbladder adenomyomatosis and anatomical variants of biliary tract by preoperative MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in the experimental group was significantly lower than that in the control group (0% vs. 5.63%, P < 0.05). The length of stay in the experimental group was shorter than that in the control group (P < 0.05).
Conclusion
Routine MRCP before LC can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by ultrasound. MRCP helps surgeons better understand the anatomical variation of extrahepatic bile duct, plan the operation rationally and efficiently reduce the occurrence of postoperative complications. Moreover, MRCP shorten the length of stay without increasing the hospitalization costs.
... Anatomical variation of the bile duct, acute in ammation of the gallbladder, stone incarceration in the gallbladder neck, gallbladder-colic stula and Mirizzi syndrome will increase the di culty of surgery, which are also factors that can easily cause bile duct injury in LC [16,17,26].The surgeon can objectively judge the severity of cholecystitis and the thickness of the gallbladder wall by MRCP, which is helpful to estimate the di culty of surgery, prevent bile duct injury and reduce the incidence of conversion to laparotomy [5]. Preoperative MRCP is also helpful for the diagnosis of Mirizzi syndrome and the selection of appropriate surgical methods to minimize the occurrence of bile duct injury [27]. In non MRCP group, one patient with common bile duct injury failed to detect the bile duct variation by preoperative abdominal ultrasound, which may be one of the reasons for bile duct injury. ...
Background: In the past quite a long time, intraoperative cholangiography（IOC）was necessary during laparoscopic cholecystectomy (LC). Now magnetic resonance cholangiopancreatography (MRCP) is the main method for diagnosing common bile duct stones (CBDS). Whether MRCP can replace IOC as routine examination before LC is still inconclusive. The aim of this study was to analyze the clinical data of patientsundergoing LC for cholecystolithiasis, and to explore the necessity and feasibility of preoperative routine MRCP in patients with cholecystolithiasis.
Methods: According to whether MRCP was performed before operation, 184 patients undergoing LC for cholecystolithiasis in the Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University from January 1, 2017 to December 31, 2018 were divided into non-MRCP group and MRCP group for this retrospective study. The results of preoperative laboratory test, abdominal ultrasound and MRCP, biliary related comorbidities, surgical complications, hospital stay and hospitalization expenses were compared between the two groups.
Results: Among the 184 patients, there were 83 patients in non-MRCP group and 101 patients in MRCP group. In MRCP group, the detection rates of cholecystolithiasis combined with CBDS and common bile duct dilatation by MRCPwere higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in non-MRCP group (8.43%) was significantly higher (P < 0.05) than that in MRCP group (0%). There was no significant difference in hospital stay (P > 0.05), but there was significant difference in hospitalization expenses (P < 0.05) between the two groups. According to the stratification of gallbladder stone patients with CBDS, hospital stay and hospitalization expenses were compared, and there was no significant difference between the two groups (P > 0.05).
Conclusions: The preoperative MRCP can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by abdominal ultrasound, which is helpful to plan the surgical methods and reduce the surgical complications. From the perspective of health economics, routine MRCP in patients with cholecystolithiasis before LC does not increase hospitalization costs, and is necessary and feasible.
... A cross-sectional prospective study conducted on the role of MRCP to assess the prevalence of anatomical variations in pancreatic duct on 377 (52% females and 48% males) subjects documented that duct of Santorini was detected in 0.8% subjects (66.6% females and 33.3% males). 21 Simkins 22 and Millbourn 23 recorded Wirsung's duct as the main duct in 90% cases. The current cross-sectional observational study suggests that the duct of Wirsung is the main mode of all 10 cadaveric specimens. ...
: The exocrine part of the pancreas has a duct system called the pancreatic ductal system (PDS). Its mechanism of
development is complex, and any reorganization during early embryogenesis can give rise to anatomical variants. The aim
of this study is to collect, classify, and analyze published evidence on the importance of anatomical variants of the PDS,
addressing gaps in our understanding of such variations. The MEDLINE, Web of Science, Embase, and Google Scholar
databases were searched to identify publications relevant to this review. R studio with meta-package was used for data
extraction, risk of bias estimation, and statistical analysis. A total of 64 studies out of 1,778 proved suitable for this review
and metanalysis. The meta-analysis computed the prevalence of normal variants of the PDS (92% of 10,514 subjects). Type
3 variants and “descending” subtypes of the main pancreatic duct (MPD) predominated in the pooled samples. The mean
lengths of the MPD and accessory pancreatic duct (APD) were 16.53 cm and 3.36 cm, respectively. The mean diameters of the
MPD at the head and the APD were 3.43 mm and 1.69 mm, respectively. The APD was present in only 41% of samples, and
the long type predominated. The pancreatic ductal anatomy is highly variable, and the incorrect identification of variants
may be challenging for surgeons during ductal anastomosis with gut, failure to which may often cause ductal obstruction or
pseudocysts formation.
Objective: To determine the frequency of anatomical variations and congenital anomalies of pancreatobiliary tract in adults through the Magnetic Resonance Cholangiopancreatography (MRCP).Methods: This cross-sectional observational study was done on patients suspected to have pancreatobiliary disease referred to MRI unit. MRCP was performed on a 1.5 Tesla in MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSF-SE technique. Axial and coronal source images and reformatted images were evaluated together for the possibility of any anomaly and variation in pancreatobiliary tract. Analysis was done by SPSS version 20.Results: Total no of 377 patients included in this study. The patients presented with epigastric pain, obstructive jaundice, pancreatitis and post-cholecystectomy epigastric pain and jaundice. MRCP was performed on these patients to examine the pancreatobiliary tract. In this study, 52% were females and 48% were males. The variations and anomalies were found in 24.93 and 75.07% had normal anatomy of pancreatobiliary tract. The most observed frequency was low insertion of cystic duct and least observed frequency was duct of Santorini. High insertion of cystic duct, absent gallbladder and aberrant hepatic ducts were not found in this study.Conclusion: Majority of the patients in this study were found to be free from pancreatobiliary disease. It is important to clarify the anatomy of the pancreatobiliary tract by preoperative evaluation. Congenital anomalies and anatomical variation in pancreatobiliary tract present a complex spectrum, which areworthy of alteration in both the clinical and surgical setting and are readily identified by MRCP.
