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La colangio-RM preoperatoria di routine o su indicazione?

La diffusione della Videolaparocolecistectomia ha comportato da un lato un incremento della compliance dei pazienti nei confronti dell’intervento e quindi una crescita esponenziale del numero di interventi stesso. Dall’altro lato ha fatto registrare un modesto ma significativo aumento delle complicanze a carico delle vie biliari come lesioni accidentali della VBP, fistole biliari, calcolosi residua. Tale riscontro appare stabile  a prescindere dalla fase della curva di apprendimento.
La disponibilità di un presidio non invasivo, privo di rischio radiologico, come la RM, utilizzato di routine permetterebbe di identificare anomalie delle vie biliari in grado di indurre il chirurgo in errore durante l’intervento, fare uno screening dei pazienti in cui  eventualmente  proporre in prima istanza un intervento open, identificare i pazienti portatori di una calcolosi della via biliare principale in modo da proporre l’intervento più adeguato. La nostra esperienza  è molto incoraggiante in tal senso.

Nell’ambito della SSC vorremmo invitare i Colleghi ad un confronto su questo argomento al fine di  proporre eventualmente uno studio multicentrico sulla validità di una colangiografia-RM routinaria come metodo di prevenzione  delle complicanze biliari.

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