Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: Review of the literature and a comparison with open intraoperative ultrasonography

Background: Laparoscopic ultrasonography (LUS) has been used increasingly o ver the last several years as a new imaging modality. To define the role of LUS during laparoscopic cholecystectomy, we evaluated LUS by prospectively comparing it with operative cholangiography (OC), by reviewing the literat ure on LUS, and by retrospectively comparing it with intraoperative ultraso nography performed during open cholecystectomy. Study Design: LUS and OC were compared prospectively in 100 consecutive pat ients during laparoscopic cholecystectomy. The success rate of examination, the time required, the accuracy in diagnosing bile duct calculi, and the d elineation of biliary anatomy were evaluated. Results: The success rate of examination was 95% for LUS and 92% for OC. Th e main reason for unsatisfactory LUS was incomplete visualization of the di stal common bile duct. The time required was 8.2 minutes for LUS and 15.9 m inutes for OC (p < 0.0001). Nine patients had bile duct calculi. LUS had on e false-negative result and OC had two false-positives and one false-negati ve. The accuracies of LUS and OC were comparable except for a slightly bett er positive predictive value of LUS (100% versus 77.8%; p > 0.1). In a lite rature review, 12 recent prospective studies comparing LUS and OC and three studies on open intraoperative ultrasonography were reviewed. Twelve studi es of LUS with a total of 2,059 patients demonstrated results similar to th e present study. The success rate was 88% to 100% for both tests. The time for LUS was approximately 7 minutes, about half of the time needed for OC. Overall, LUS was associated with fewer false-positive results than OC; the positive predictive value and specificity of LUS were better, while the sen sitivity and negative predictive value of LUS and OC were comparable. OC de tected ductal variations or anomalies more distinctly than LUS. Compared wi th open intraoperative ultrasonography, LUS had a slightly lower success ra te and required a slightly longer time because it was technically more dema nding, but the two procedures had a similar accuracy for diagnosing bile du ct calculi. Conclusions: Because of their different advantages and disadvantages, LUS a nd OC can be used in a complementary manner. There is a learning curve for LUS because of its technical difficulty. Once learned, however, LUS can be used as the primary screening procedure for bile duct calculi because of it s safety, speed, and cost-effectiveness. OC can be used selectively, partic ularly when ductal anatomic variations or anomalies or bile duct injuries a re suspected. (J Am Coil Surg 1999;188:361-367. (C) 1999 by the American Co llege of Surgeons).