COMMON BILE-DUCT EXPLORATION AND LAPAROSCOPIC CHOLECYSTECTOMY - ROLE OF INTRAOPERATIVE ULTRASONOGRAPHY

Background: In October 1993, to detect associated common bile duct (CB D) stones, we started an evaluation program of patients with symptomat ic cholelithiasis who were candidates for laparoscopic cholecystectomy . Study Design: We used a standard preoperative algorithm and a laparo scopic ultrasonographic (LUS) examination. Preoperative endoscopic ret rograde cholangiopancreatography (ERCP) was reserved for high-risk pat ients for CBD stones. Laparoscopic ultrasonographic examination during cholecystectomy was routinely performed to identify stones unsuspecte d preoperatively. Two-hundred-sixteen patients with symptomatic cholel ithiasis were included in the study; 177 patients (82%) were at low ri sk for choledocholithiasis and 39 patients (18%) were at high risk and had preoperative ERCP. In 17 patients (43.5%) CBD stones were found, and in 16 patients (41%) they were removed by endoscopic sphincterotom y. Results: In all patients, the main intra- and extrahepatic ducts we re well documented by LUS, but in eight cases the distal tract of the CBD was not well-visualized. In eight patients, small stones were foun d in the CBD. A subsequent peroperative cholangiography or CBD explora tion confirmed the diagnosis. In one patient, both LUS and cholangiogr aphy suspected a small stone; the CBD exploration did not confirm it ( false positive). In two patients a small stone in the CBD was found du ring the followup period (two false negatives). An endoscopic sphincte rotomy solved the problem. Conclusions: Laparoscopic ultrasonographic examination may be a real alternative to cholangiography during laparo scopic cholecystectomy: this may be reserved for selected instances on the basis of LUS finding. On the other hand, considerable ultrasonogr aphic experience is required for LUS to be performed successfully. (C) 1997 by the American College of Surgeons.