INTRAOPERATIVE ULTRASONOGRAPHY (IOUS) DURING LAPAROSCOPIC CHOLECYSTECTOMY

Background: The purpose of this study was to evaluate the usefulness o f intraoperative ultrasonography (IOUS), a new method of imaging the b iliary tree and related structures, during laparoscopic cholecystectom y. Method: An IOUS probe (Aloka, Tokyo, Japan) with a 7.5-MHz linear-a rray transducer was used during cholecystectomy in 124 patients with s ymptomatic cholelithiasis (45 men, 79 women; mean age, 48 +/- 14 years ). Results: The examination of the common bile duct (CBD) was excellen t in 117 patients but unsatisfactory in 7 cases (5.6%) at the level of the head of the pancreas. In 5 patients, IOUS showed unsuspected chol edocholithiasis: a subsequent intraoperational cholangiogram confirmed this. In five cases IOUS was able to help the surgeon to localize a C alot area obscured by inflammation. Postoperatively, one patient had a n injury of the cystic duct stump: a nasobiliary tube resolved the bil e leakage after 7 days. Another patient was submitted to postoperative endoscopic retrograde cholangiopancreatography (ERCP) for a choledoch olithiasis recognized by a trans-cystic-tube cholangiography: the ston e was suspected but not demonstrated either by laparoscopic IOUS or by intraoperative cholangiography. During the follow-up period, one pati ent had an episode of acute pancreatitis. ERCP showed a small stone we dged in the sphincter of Oddi. Conclusions: IOUS may be a real alterna tive to cholangiography during laparoscopic cholecystectomy since it i s safer and offers a complete examination of the biliary tree. It has some disadvantages which can solved by additional experience.