Abstract
Laparoscopic sonography was introduced at our institution in April 1991. It is presently being tested as an alternative to peroperative cholangiography as far as the visualization of the structures of the hepatoduodenal ligament — particularly the extrahepatic bile ducts — during laparoscopic cholecystectomy are concerned. So far, 75 patients have been examined with both modalities. The structures of the hepatoduodenal ligament could be seen sonographically in all patients, while in five patients, the cholangiography had to be aborted for technical reasons. Eleven patients (15%) had anatomical variations of the bile ducts. Nine of these were diagnosed sonographically. A duodenal diverticulum and a long common channel of common bile duct and pancreatic duct were seen only on cholangiography. Variations of the hepatic arteries were found in 15 patients (20%). We conclude that intraoperative laparoscopic sonography is a reliable tool for the visualization of the structures of the hepatoduodenal ligament. This new technique might replace peroperative cholangiography in the future.
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References
Beaver MG (1929) Variations in the extrahepatic biliary tract. Arch Surg 19: 321–326
Berci G, Sackier JM, Paz-Partlow M (1991) Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy? Am J Surg 161: 355–360
Buckley AR, Scudamore CH, Becker CD, Cooperberg PL (1987) Intraoperative imaging of the biliary tree; sonography vs. operative cholangiography. J Ultrasound Med 6: 589–595
Charels K, Klöppel G (1989) The bile duct system and its anatomical variations. Endoscopy 21: 300–308
Flint ER (1923) Abnormalities of the right hepatic, cystic and gastroduodenal arteries, and of the bile-ducts. Br J Surg 10: 509–519
Frierson HF Jr (1989) The gross anatomy and histology of the gallbladderm extrahepatic bile ducts, Vaterian system and minor papilla. Am J Surg Pathol 13: 146–162
Hayes MA, Goldenberg IS, Bishop CC (1958) The developmental basis for bile duct anomalies. Surg Gynecol Obstet 107: 447–456
Heloury Y, Leborgne J, Rogez JM, Robert R, Lehur PA, Pannier M, Barbin JY (1985) Radiological anatomy of the bile ducts based on intraoperative investigation in 250 cases. Anat Clin 7: 93–102
Jakimovicz JJ, Rutten H, Jürgens PJ, Carol EJ (1987) Comparison of operative ultrasonography and radiography in screening of the common bile duct for calculi. World J Surg 11: 628–634
Kochhar R, Nagi B, Chawla S, Das K, Rao KLN, Mitra SK, Mehta SK (1989) The clinical spectrum of anomalous pancreatobiliary junction. Surg Endosc 3: 83–86
Lane RJ, Coupland GA (1982) Ultrasonic indications to explore the common bile duct. Surgery 91: 268–274
Moosman DA, Coller FA (1951) Prevention of traumatic injury to the bile ducts. Am J Surg 82: 132–143
Phillips EH, Berci G, Carroll B, Daykhovsky L, Sackier J, Paz-Partlow M (1990) The importance of intraoperative cholangiography during laparoscopic cholecystectomy. Am Surg 56: 792–795
Röthlin M, Schlumpf R, Largiadèr F (1991) Die technik der intraoperativen sonographie bei der laparoskopischen cholecystektomie. Chirurg 62: 899–901
Ruge E (1908) Beiträge zur chirurgischen anatomie der grossen gallenwege. Arch f klin Chir 87: 47–52
Sigel B, Machi J, Beitler JC, Donahue PE, Bombeck CT, Baker RJ, Duarte B (1983) Comparative accuracy of operative ultrasonography and cholangiography in detecting common duct calculi. Surgery 94: 715–720
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Röthlin, M., Largiadèr, F. The anatomy of the hepatoduodenal ligament in laparoscopic sonography. Surg Endosc 8, 173–180 (1994). https://doi.org/10.1007/BF00591825
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DOI: https://doi.org/10.1007/BF00591825