INTRAOPERATIVE ULTRASONOGRAPHY - ALTERNATIVE TO CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY - PROSPECTIVE-STUDY

The aim of this prospective study was the comparison of laparoscopic s onography with intraoperative cholangiography (IOC) during laparoscopi c cholecystectomy. A 360-degrees-sector scanner with a frequency of 5. 5 MHz was used. The examination was successful in all 69 patients ente red into the study. In the beginning 19 patients were examined sonogra phically without subsequent IOC. None of these patients had bile duct stones and their postoperative history was uneventful. In the 50 patie nts operated on subsequently both laparoscopic sonography and IOC were tried. IOC was not performed due to technical failure in 4 patients a nd due to allergic reactions to contrast media in one patient. Thirty- one patients demonstrated normal bile ducts without stones in both exa minations. Ten patients had dilated ducts without stones. In three cas es a stone was seen on IOC and intraoperative sonography. In one case a duodenal diverticulum containing debris, demonstrated by IOC, was th e reason for a false positive sonographic finding. Sensitivity and spe cificity of laparoscopic sonography concerning the visualisation of bi le duct stones were 100 and 98 %, respectively. The time necessary for the examination was significantly shorter in laparoscopic sonography than in intraoperative cholangiography (p = 0.0001). If these results can be reproduced in a larger population of patients, laparoscopic son ography can be considered a safe, fast and non-invasive alternative to intraoperative cholangiography.