USE OF INTRAOPERATIVE ULTRASONOGRAPHY DURING HEPATOLITHECTOMY

Complete clearance of intrahepatic stones has long been a major surgic al challenge. To reduce the incidence of residual stones, we used intr aoperative ultrasonography (IOUS) to localize them and guide lithectom y in 38 patients with hepatolithiasis between July 1988 and December 1 993. All patients had multiple intrahepatic stones; 24 had accompanyin g extrahepatic calculi. Hepatic stones were confined to the left intra hepatic biliary tract in 13 patients, to the right in 9, and in both l obes in 16. Twenty-three patients underwent common bile duct explorati on followed by T-tube drainage, 8 had transhepatic lithotomy with or w ithout choledocholithotomy, 3 had choledocolithotomy and Roux-en-Y sid e-to-side choledochojejunostomy, and 2 had hepaticojejunostomy, left l obectomy was performed in the remainder. In 35 patients cholecystectom y was performed at the same time. Complete clearance of the stones was achieved in 36 patients (94.7%). The incidence of retained stone was decreased to 5.3%. No associated complications occurred. IOUS can accu rately localize intrahepatic calculi, directly orient lithotomy instru ments to approach the stones, demonstrate the spatial relation between stone and intrahepatic critical structure, and thereby choose an opti cal route for transhepatic lithotomy. Imaging can be repeated at any t ime with no radiation exposure to the patient or the medical staff.