IMPACT OF CYSTIC DUCT EVALUATION BY MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY BEFORE LAPAROSCOPIC CHOLECYSTECTOMY TO MINIMIZE POST CHOLECYSTECTOMY SYNDROME: A MULTICENTER STUDY

Abstract

Background: Post-cholecystectomy syndrome (PCS) encompasses a range of persistent abdominal symptoms following cholecystectomy. Incomplete evaluation of the cystic duct (CD) anatomy is a significant etiological factor.  Objective: To determine the impact of preoperative Magnetic Resonance Cholangiography (MRCP) in delineating CD anatomy on the prevention of post-cholecystectomy syndrome (PCS). Methods: This prospective cross-sectional study was conducted at Ibne Sina Diagnostic & Consultation Center (Uttara), Popular Diagnostic Center (Savar), Super Medical Hospital (Savar) And Enam Medical College Hospital (Savar), Dhaka, from January 2019 to December 2021. A purposive sample of 109 patients undergoing elective laparoscopic cholecystectomy was enrolled. All participants underwent preoperative Magnetic Resonance Cholangiography (MRCP) for precise mapping of cystic duct anatomy. Surgical strategies were subsequently tailored based on the MRCP findings. Patients were prospectively followed for 1 year postoperatively to identify any symptoms of Post-cholecystectomy Syndrome (PCS). Data analysis was performed using SPSS version 23.0, employing descriptive statistics, chi-square tests, and regression analysis. Results: Preoperative MRCP identified cystic duct variants in 34.9% of patients. The overall incidence of PCS was 9.2%. A significant association was found between cystic duct variants and PCS development (p=0.003). Surgical adaptation based on MRCP findings resulted in a significantly lower PCS rate (4.3% vs. 12.7%, p=0.012). MRCP demonstrated high diagnostic accuracy (Sensitivity: 96.2%, Specificity: 98.6%) for delineating cystic duct anatomy. Conclusion: Routine preoperative MRCP for cystic duct mapping significantly reduces the incidence of post-cholecystectomy syndrome. It enables proactive surgical planning, leading to more definitive dissection and addressing a key etiology of PCS. Its integration into clinical practice is highly recommended.