SPIRAL COMPUTED-TOMOGRAPHY SCANNING AFTER INTRAVENOUS-INFUSION CHOLANGIOGRAPHY FOR BILIARY DUCT ANOMALIES

BACKGROUND: latrogenic injury of the bile duct during cholecystectomy represents a failure of surgical technique, especially for laparoscopi c surgery, Knowledge of the patient's individual ductal anatomy and an omalies preoperatively would be helpful in avoiding such injuries, The refore, we investigated the anatomy of the biliary duct and any anomal ies using spiral computed tomography (SCT) scanning following intraven ous infusion cholangiography (IVC-SCT), MATERIALS: Laparoscopic cholec ystectomies (LC) were attempted on 437 patients at the Kansai Medical University. Preoperative IVC-SCT and laparoscopic cholangiography were attempted in all of the patients. RESULTS: An overall anomalous union of the cystic duct was seen in 71 (16.2%) out of the 437 patients sub jected to IVC-SCT, The following anomalies were observed: right hepati c duct entry in 7 cases (1.6%), parallel low entry in 17 cases (3.9%), posterior spiral entry in 35 cases (8.0%), anterior spiral entry in 7 cases (1.6%), and accessory duct entry in 5 cases (1.1%), The success rate for the LC was 99.5% (435/437), Three patients were switched to open surgery owing to advanced gallbladder cancer and severe adhesions . The success rate for the laparoscopic cholangiography was 97.2% (423 of 435). Intraoperative right hepatic duct injury occurred in only 1 patient with a bile duct anomaly, and it was repaired with laparoscopi c T-tube drainage. CONCLUSIONS: The preoperative examination of the bi liary tract by IVC-SCT was technically simple, less invasive, and may helpful in avoiding damage to the bile duct, especially in patients wi th biliary duct anomalies. (C) 1997 by Excerpta Medica, Inc.