Laparoscopic ultrasonography and operative cholangiography prevent residual common bile duct stones in laparoscopic cholecystectomy

We retrospectively evaluated the role of intraoperative cholangiography, (I OC) combined with laparoscopic intraoperative ultrasonography (LIOU) for de tection of common bile duct (CBD) stones in patients undergoing laparoscopi c cholecystectomy. We reviewed 184 patients with biliary stones. Preoperati vely, all patients underwent ultrasonography (US); 183 of the patients were investigated by cholangio,graphy (oral and intravenous cholangiography,oio graphy in 145 and endoscopic retrograde cholangiography in 44). LIOU was ca rried out in all patients and IOC was done in 183. LIOU visualized the bile duct in 94.6% of the patients and IOC was successful in 95.6%. CBD stones were detected in a total of 17 patients, 9 (52.9%) of whom were positive on preoperative investigations. The sensitivity for detecting CBD stones was 29.4% with US, 22.2% with oral and intravenous cholangiography, 50.0% with endoscopic retrograde cholangiography, 82.4% with LIOU, and 93.3% with IOC. The diameter of the stones visualized intraoperatively (4.4 +/- 1.2 mm) wa s smaller than that of the stones detected preoperatively (6.9 +/- 2.6 mm). The stones were removed during laparoscopy in 15 patients and after conver sion to laparotomy in 2. None of the patients had residual CBD stones after follow-up for 6 to 50 months. Intraoperative examination using both LIOU a nd IOC was useful for prevention of residual CBD stones.