THE ANATOMY OF THE HEPATODUODENAL LIGAMENT IN LAPAROSCOPIC SONOGRAPHY

Laparoscopic sonography was introduced at our institution in April 199 1. It is presently being tested as an alternative to peroperative chol angiography as far as the visualization of the structures of the hepat oduodenal ligament - particularly the extrahepatic bile ducts - during laparoscopic cholecystectomy are concerned. So far, 75 patients have been examined with both modalities. The structures of the hepatoduoden al ligament could be seen sonographically in all patients, while in fi ve patients, the cholangiography had to be aborted for technical reaso ns. Eleven patients (15%) had anatomical variations of the bile ducts. Nine of these were diagnosed sonographically. A duodenal diverticulum and a long common channel of common bile duct and pancreatic duct wer e seen only on cholangiography. Variations of the hepatic arteries wer e found in 15 patients (20%). We conclude that intraoperative laparosc opic sonography is a reliable tool for the visualization of the struct ures of the hepatoduodenal ligament. This new technique might replace peroperative cholangiography in the future.