MRCP and microincision of the cystic duct can prevent residual gallstones: A single-center experience

Abstract Background: Residual gallstones are an infrequent but troublesome complication after laparoscopic cholecystectomy (LC). This study aimed to explore the feasibility of routine preoperative magnetic resonance cholangiopancreatography (MRCP) examination and intraoperative microincision of the cystic duct in preventing residual gallstones after LC surgery. Methods: This report presents a summary and analysis of 1217 cases of gallbladder stones treated by LC in the People's Hospital of Nyingchi from January 2016 to August 2021. According to the different measures taken to prevent residual gallstones, it is divided into 3 phases. In phase 1, there is no preoperative MRC examination P and intraoperative microincision. In phase 2, preoperative MRCP examination was performed without intraoperative microincision. In phase 3, both preoperative MRCP examination and intraoperative microincision were performed. Then the differences in residual gallstones at different phases were analyzed. And further analysis of preoperative MRCP and intraoperative microincision case data was performed to assess feasibility in phase 3, including the extra cost posed by the MRCP examination, operation time, volume of blood loss, and presence of residual gallstones after surgery. Results: In phase 1, 0.63% (3/473) of patients had residual gallstones after LC surgery; in phase 2, 0.24% (1/418) of patients had residual gallstones; in phase 3, no patients residual gallstones were present (0/326). Feasibility analysis for Phase 3 showed that 7.98% of cases of silent choledocholithiasis that were not detected by abdominal ultrasound were detected by MRCP, and MRCP examination only accounted for 9.45% of the total hospitalization expenses, which could effectively reduce the missed diagnosis of cholecystolithiasis combined with choledocholithiasis. The average time of microincision and squeezing of the cystic duct during the operation was 3 to 5 minutes, and the bleeding volume was 1 to 3 ml, indicating that microincision of the cystic duct was safe and easy to perform. Sedimentary stones or flocs could be squeezed out by this technique in 21% of LC cases, which could effectively reduce the risk of secondary choledocholithiasis stones after surgery. Conclusion: These data show that routine preoperative MRCP examination and intraoperative microincision of the cystic duct can effectively prevent residual gallstones after LC.