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Background: Detailed preoperative delineation of biliary tract anatomy plays a pivotal role in guiding surgeons completing laparoscopic cholecystectomy (LC) smoothly. Hereby, we retrospectively investigated the potential impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on LC., Patients and Methods: In this study, clinical data of LC patients who received conventional preoperative examinations from January 2008 to December 2010 (Ctrl group, n = 300) versus conventional examinations plus extra preoperative MRCP assessment between January 2011 and December 2013 (MRCP group, n = 300) were randomly retrieved. The ratios of conversion to open cholecystectomy and various postoperative morbidities were respectively analyzed., Results: In total, the incidences of operation conversion, postoperative remnant cystic duct stone, and choledocholithiasis in the MRCP group were 12 (4.0%), 1 (0.3%), and 2 (0.7%), respectively, all evidently lower than those in the Ctrl group: 41 (13.7%), 7 (2.3%), and 9 (3.0%). In addition, the MRCP group also presented with fewer cases of bile duct injury and incidental gallbladder carcinoma compared with the Ctrl group (1 versus 5 and 1 versus 2, respectively), although none of the variances was statistically significant., Conclusions: Our results demonstrated that preoperative MRCP had a robust safeguarding effect on LC and deserves further promotion.

Aim: To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones., Methods: Four databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011, were searched to identify all randomized controlled trials (RCTs). Data were extracted from the studies by two independent reviewers. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, number of procedures per patient, length of hospital stay, total operative time, hospitalization charges, patient acceptance and quality of life scores., Results: Seven eligible RCTs [five trials (n = 621) comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC + laparoscopic common bile duct exploration (LCBDE); two trials (n = 166) comparing postoperative ERCP/EST + LC with LC + LCBDE], composed of 787 patients in total, were included in the final analysis. The meta-analysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) = -0.10, 95% confidence intervals (CI): -0.24 to 0.04, P = 0.17], postoperative morbidity (RR = 0.79, 95% CI: 0.58 to 1.10, P = 0.16), mortality (RR = 2.19, 95% CI: 0.33 to 14.67, P = 0.42), conversion to other procedures (RR = 1.21, 95% CI: 0.54 to 2.70, P = 0.39), length of hospital stay (MD = 0.99, 95% CI: -1.59 to 3.57, P = 0.45), total operative time (MD = 12.14, 95% CI: -1.83 to 26.10, P = 0.09). Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management., Conclusion: Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient's condition, operator's expertise and local resources should be taken into account in making treatment decisions.