Furthermore, the incidence of worrisome haemorrhages and biliary complications has not been influenced by the technique shift. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Two patients with biliary obstruction from iatrogenic early post-laparoscopic cholecystectomy biliary injuries. cal clips and staples and their MRI safety compatibility (Table 2). Unable to process the form. Other type of clips: Examinations may be done a few weeks after an operation. Borrowing from initial experiences in the setting of acute pancreatitis, diffusion-weighted MRI will probably enable confident differentiation between sterile and infected postoperative, the latter showing peripheral bright signals in high b-value diffusion images and corresponding low apparent diffusion coefficient values . Kenneth R. Hassler, Mark W. Jones. Afterwards, most iatrogenic complications following open, converted, laparoscopic and laparo-endoscopic rendezvous cholecystectomy are reviewed with examples, including infections, haematoma and active bleeding, residual choledocholithiasis, pancreatitis, biliary obstruction and leakage. 18). On the 6th postoperative day, CT (a–c) showed residual intraperitoneal air (+ in a), usual collection at gallbladder fossa (* in b), “mottled” liver parenchymal enhancement and bilateral dilatation of intrahepatic bile ducts. Radiographics 27:477–495, Catalano OA, Sahani DV, Forcione DG et al (2009) Biliary infections: spectrum of imaging findings and management. The patient underwent open cholecystectomy. AJR Am J Roentgenol 191:794–801, Lohan D, Walsh S, McLoughlin R, Murphy J (2005) Imaging of the complications of laparoscopic cholecystectomy. At cross-sectional imaging, the identification of a collection with features consistent with biloma raises concern for underlying leakage. 8) should not be reported as abnormal. Surgical clips are applied during cholecystectomy on the cystic duct and artery. AJR Am J Roentgenol. 11) [27, 33]. 14) [10,11,12,13,14]. Additional focused contrast-enhanced CT image (b) better showed the metallic clips and the MIP image (c) depicted the dilated intrahepatic bile ducts. Compared to traditional open cholecystectomy, laparoscopy minimised the perioperative mortality and duration of hospitalisation and allowed for an earlier return to normal activities with cosmetically acceptable results. Some blood (Fig. 15), inadvertent CBD clipping, thermal injury and extrinsic compression by an abnormal collection [27, 28]. Following recent surgery, MRCP provides a comprehensive visualisation of the operated biliary tract, and can, therefore, allow accurate detection of the obstruction site and features, and differentiation among causes of biliary dilatation, such as retained gallstones (Fig. If you check the following article that is found in 'Inside Surgery' you'll find that clips are routinely used to seal off the cystic duct and some blood vessels during lap. Residual lithiasis and cholangitis after laparoscopic cholecystectomy, developing despite preoperative ERCP. Albeit generally considered safe, cholecystectomy may result in adverse outcomes with non-negligible morbidity. 9). Tonolini, M., Ierardi, A.M., Patella, F. et al. Fred_Flintstone. 6) and by haemostatic agents such as Surgicel™ (oxidised regenerated cellulose), which appear as complex collections with 40–50 HU attenuation and intermixed gaseous foci [10,11,12,13,14]. Specifically, some surgeons tried to decrease the size and number of ports to improve cosmetic and postoperative outcomes, until the most recent development represented by the single-site laparoscopic cholecystectomy. Abdom Imaging 39:398–410, Hoeffel C, Azizi L, Lewin M et al (2006) Normal and pathologic features of the postoperative biliary tract at 3D MR cholangiopancreatography and MR imaging. https://doi.org/10.1007/s13244-018-0663-9, DOI: https://doi.org/10.1007/s13244-018-0663-9, Over 10 million scientific documents at your fingertips, Not logged in Using focused reconstructions, CT (Fig. World J Emerg Surg 11:25, Okamoto K, Suzuki K, Takada T et al (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. According to the 2018 Tokyo Guidelines, laparoscopic cholecystectomy performed “as soon as possible” represents the preferred treatment of acute cholecystitis if compatible with the patient’s status according to the Charlson comorbidity index and the American Society of Anaesthesiologists (ASA) classification [20, 21]. Many reports have described its usefulness and diagnostic accuracy in evaluating various pancreatobiliary abnormalities (,2–,5), and, according to some reports, in many instances MRCP can replace diagnostic ERCP (,6,,7). Report / Delete. 7b, 9 and 19). Gallbladder fossa abscess (*) observed after open cholecystectomy converted from laparoscopic cholecystectomy because of gallbladder perforation and intraperitoneal spillage of infected bile, sonographically (a) seen as ovoid well-demarcated infrahepatic collection with inhomogeneous hypo-anechoic structure. 42, No. Unfortunately, the incidence of post-cholecystectomy haemorrhage and biliary injuries has not been influenced by the technique shift. Emphasis is placed on CT as the “workhorse” modality, on the role of MRI with magnetic resonance cholangiopancreatography (MRCP) and additional gadoxetic acid-enhanced MRCP to provide a non-invasive, combined anatomic and functional assessment of the operated biliary tract [10,11,12,13,14]. Deep infections complicating either open or laparoscopic cholecystectomy are rare (overall incidence below 1%) but the risk becomes higher (approximately 3%) after intraoperative spillage of gallstones [17,18,19]. The faintly calcific fragment (arrow in c) corresponded to a dropped gallstone. 2 … Cir Esp 95:465–470, Nuzzo G, Giuliante F, Giovannini I et al (2008) Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy. 5) in the gallbladder fossa and transient oedema of the adjacent liver parenchyma (Fig. c, d In another patient, on the 4th postoperative day, T2- (c) and T1- (d) weighted MR images showed a moderate-sized inhomogeneous collection (arrowheads) with signal intensity features consistent with subacute blood. Respectively following laparoscopic and open cholecystectomy, the trocar access (Fig. Two studies reported that iatrogenic complications represent a common cause of claims, particularly related to delayed diagnosis and (mis)management of bile duct and vascular injuries. Reconstructing thick-slab maximum intensity projection (MIP) images is helpful to visualise the course of surgical drains, to improve the detection of active bleeding and to provide a vascular roadmap to the interventional radiologist if embolisation is considered. Arch Surg 145:1145–1149, Jara G, Rosciano J, Barrios W et al (2017) Laparoscopic subtotal cholecystectomy: a surgical alternative to reduce complications in complex cases. Following laparoscopic cholecystectomy, the amount of intraperitoneal gas is generally scarce, since insufflated CO 2 is rapidly absorbed. The length of the shaft is approximately 33 cm (13”). Laparoscopic cholecystectomy: incidents and complications. Still performed in many areas of the world, nowadays, open cholecystectomy remains indicated when laparoscopic cholecystectomy is unfeasible or fails. Typically, the body will 'wall off' the clips with an overgrowth of connective tissue. • Magnetic resonance cholangiopancreatography (MRCP) is the best modality to provide anatomic visualisation of the operated biliary tract and is indicated when biliary complications are suspected. The risk is highest when MRCP has not been obtained before laparoscopic cholecystectomy. Google Scholar, Islim F, Salik AE, Bayramoglu S, Guven K, Alis H, Turhan AN (2014) Non-invasive detection of infection in acute pancreatic and acute necrotic collections with diffusion-weighted magnetic resonance imaging: preliminary findings. Urgent MRCP allows rapid, accurate assessment of presence, level and length of injury, plus detection of subhepatic collections. Coronal (e) gadoxetic acid-enhanced MRCP image showed well-opacified bile in the common bile duct (arrowhead) and short cystic duct remnant (arrow), and no filling of the biloma, which was attributed to a sealed leak from small peripheral bile radicle. Guidelines for MRI in Patients with GI Clips. Although a rare complication of laparoscopic cholecystectomy, surgical clip migration is a well-documented event with several case reports published. Google Scholar, Agabiti N, Stafoggia M, Davoli M, Fusco D, Barone AP, Perucci CA (2013) Thirty-day complications after laparoscopic or open cholecystectomy: a population-based cohort study in Italy. mri any tool can be dangerous if not used properly • “overall, it is an extremly safe procedure, but like all powerful pieces ... • aneurysm clips. Cochrane Database Syst Rev (9):CD006004, Sathesh-Kumar T, Saklani AP, Vinayagam R, Blackett RL (2004) Spilled gall stones during laparoscopic cholecystectomy: a review of the literature. © 2021 Springer Nature Switzerland AG. Until the recent past, clinical diagnosis of biliary fistula relied on the output of bile from a surgical drain, and confirmation of bile leakage required invasive (endoscopic or percutaneous) cholangiography. Viewing at lung or bone window settings eases the identification of metallic surgical staples and free or localised intra-abdominal air. Furthermore, biliary or portal venous sepsis may occasionally lead to the formation of hepatic abscesses [36, 37]. 5). Possible pitfalls of MRCP include: (a) tendency to overestimate calibre changes, (b) pneumobilia, (c) magnetic susceptibility artefacts from metallic clips, (d) flow artefact at the common hepatic duct and (e) superimposition of fluid collections (Fig. • Contrast-enhanced multidetector computed tomography (CT) is increasingly requested early after cholecystectomy and represents the “workhorse” modality that rapidly provides a comprehensive assessment of the operated biliary tract and abdomen. Twenty-four hours after surgery, contrast-enhanced CT with drainage in place (thick arrow) showed preserved enhancement of the pancreatic gland and development of peripancreatic effusion (*). 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