Role of Pre-Operative MRCP in Cholelithiasis and Choledocholithiasis – A Longitudinal Study in a Tertiary Health Care

Introduction: Cholelithiasis is a common surgical diagnosis and Laparoscopic cholecystectomy is a common surgical procedure. One of the postoperative complications of Laparoscopic cholecystectomy is retained bile duct stone due to failure of diagnosing these preoperatively. This leads to increased morbidity and mortality in postcholecystectomy patients. USG abdomen and liver function tests are routinely done preoperatively in cholelithiasis patients. These have poor sensitivity and specificity for diagnosing CBD stones. MRCP is a highly sensitive and specific investigation for CBD stone detection. Aim To evaluate the role of routine MRCP in all patients of cholelithiasis and its correlation with liver function test (S. Bilirubin, SGOT, SGPT and S. Alkaline phosphatase) and ultrasound abdomen for diagnosing CBD stones. Material and Methods: The present study was a longitudinal study done on 100 patients diagnosed to have cholelithiasis on an ultrasound abdomen with no CBD stone. All the patients were investigated with liver function tests and MRCP preoperatively for detection of missed CBD stones. Data were analyzed with SPSS software and a chi-square test was used and a p-value <0.05 was considered a level of significance. Results: The mean age of patients in this study was 52.47 years with a standard deviation of ± 41. 59 patients were female and 41 were male. Among all the 100 patients, who reported normal CBD on ultrasound abdomen, in 20 patients CBD stone was detected on MRCP. Raised liver enzymes were also related to CBD stone. Raised S. bilirubin has a PPV-66.7%, NPV – 82.97%, sensitivity-20% and specificity of 97.5%. Raised SGOT/SGPT had a PPV of 55%, NPV -88.75%, sensitivity- 55% and specificity of 88.75%. Raised S. Alkaline phosphatase has a PPV- 76%, NOV – 89.15%, sensitivity-67.85% and specificity of 92.5%. Conclusion: Routine MRCP should be done in all patients of cholelithiasis preoperatively to avoid the complication of retained common bile duct stones.