EVALUATION OF THE BILIARY TREE DURING LAPAROSCOPIC CHOLECYSTECTOMY - LAPAROSCOPIC ULTRASOUND VERSUS INTRAOPERATIVE CHOLANGIOGRAPHY - A PROSPECTIVE-STUDY OF 150 CASES

From November 1994 to March 1996, 150 patients treated by laparoscopic cholecystectomy were included in a prospective study, to compare intr aoperative cholangiography (IOC) and laparoscopic ultrasonography (LU) . The biliary tree was successively explored by these two methods in t he routine detection of common bile duct stones. The feasibility of LU was 100%. Cholangiography was performed only in 125 cases (83%). The time taken for LU was significantly shorter (11.6 vs. 17.6 minutes, p = 0.0001). In this study, common bile duct stones were found in 14 cas es (9%). For their detection, results were comparable to LU and IOC. F or LU, sensitivity was 80% and specificity 99%; and for IOC, 78 and 97 %, respectively. Both examinations combined had a 100% sensitivity and specificity. Laparoscopic ultrasonography failed to recognize the int rapancreatic part of the common bile duct in 25 cases (17%) and did no t show anatomic abnormalities detected by IOC. It did, however, detect other unsuspected intraabdominal abnormalities. Although LU is safe, repeatable, and noninvasive, a considerable learning curve is necessar y to optimize its efficacy. Comparison of relative cost must be undert aken.