COMPARATIVE-EVALUATION OF CONTACT ULTRASONOGRAPHY AND TRANSCYSTIC CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY - A PROSPECTIVE-STUDY

Background: The role of intraoperative cholangiography (IOC) during la paroscopic cholecystectomy (LC) is controversial. While many advocate its routine use, others argue for a selective approach. Recent reports showed laparoscopic contact ultrasonography (LCU) as a viable alterna tive to IOC. However, no prospective data were available to compare th e accuracy, efficacy, and safety of the two diagnostic procedures. Obj ective: To evaluate the benefits and disadvantages of LCU and IOC duri ng LC. Methods: Seventy-eight patients who underwent LC at Pisa (Italy ) and Dundee (Scotland) university hospitals were entered in a prospec tive data registry. Details of operative technique and results of LCU and IOC were analyzed by reviewing videotape recordings of each proced ure. Results: Laparoscopic cholecystectomy was achieved in 73 patients , with five requiring conversion to the open procedure. The success ra te of IOC was 90% (64/71). Performance of IOC demanded more than twice the time needed for LCU. Eleven percent (8/71) of cholangiograms were abnormal, with a false-positive rate of 1% (1/71). Laparoscopic conta ct ultrasonography detected all four instances of unsuspected ductal s tones but none of the three cases of anomalous biliary anatomy. Clinic ally relevant incidental findings were picked up by LCU in six patient s. Conclusions: Laparoscopic contact ultrasonography proved to be extr emely accurate in the detection of ductal stones but less reliable in the disclosure of anomalous biliary anatomy. The essential role of IOC in providing a clear spatial display of the biliary tract was confirm ed. Since the two procedures are complementary, their combined use is advisable in difficult LC to avoid retained common bile duct stones an d prevent iatrogenic complications.