Skip to main content
SpringerLink
Log in

The utility of intracorporeal ultrasonography for screening of the bile duct during laparoscopic cholecystectomy

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Different strategies and imaging modalities have been used to detect common bile duct (CBD) stones during laparoscopic cholecystectomy. We prospectively compared fluoroscopic intraoperative cholangiography (FIOC) and laparoscopic intracorporeal ultrasonography (LICU) in patients undergoing laparoscopic cholecystectomy for this purpose. In a consecutive series of 607 laparoscopic cholecystectomies, FIOC was used in the first 407 patients, whereas LICU was preferentially applied to the subsequent 200 patients. When LICU documented CBD stones, the duct was flushed with saline solution after intravenous administration of glucagon, and stone persistence or absence was confirmed by FIOC and/or repeat LICU. In the FIOC group, 10 patients were converted to open cholecystectomy and 16 patients did not undergo FIOC. Among the remaining 381 patients, FIOC was successful in 370 (97%). In the LICU group, two patients were converted and LICU was not performed in 26 patients. In the remaining 172 patients, the cystic duct (CBD) junction and the CBD were visualized in all cases (P <0.05 vs. FIOC). The mean (± SEM) times required to complete FIOC and LICU were 15.1 ± 0.4 minutes and 5.3 ± 0.2 minutes, respectively (P <0.0001). Choledocholithiasis was detected in 25 patients (7%) undergoing FIOC and in 22 patients (13%) undergoing LICU (P <0.05). In the LICU group, the mean sizes of the stones cleared by ampullary dilatation and flushing (17 of 22, 77 %) and those requiring more invasive methods (5 of 22, 23%) were 1.6 ± 0.2 mm and 2.7 ± 0.3 mm, respectively (P <0.01). Sludge was seen in the CBD by LICU in 10 patients (6%), which disappeared with flushing in all cases. LICU is accurate, safe, and permits more rapid evaluation of bile duct stones than FIOC during laparoscopic cholecystectomy. LICU may be overly sensitive in detecting small stones and sludge, which are of questionable significance. Stones 2 mm or less can usually be cleared by flushing, whereas larger ones often require invasive techniques for removal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cuschieri A, Shimi S, Banting S, Nathanson K, Pietrabissa A. Intraoperative cholangiography during laparoscopic cholecystectomy: Routine vs. selective policy. Surg Endosc 1994;8:302–305.

    Article  PubMed  CAS  Google Scholar 

  2. Phillips EH. Routine versus selected intraoperative cholan-giography. AmJ Surg 1993;165:505–507.

    Article  CAS  Google Scholar 

  3. Jones DB, Soper NJ. Common duct stones. In Cameron JL, ed. Current Surgical Therapy, 5th ed. St. Louis: Mosby, 1995, pp 337–342.

    Google Scholar 

  4. Jones DB, Soper NJ. Result of a change to routine fluorocholangiography during laparoscopic choledochojejunostomy. Surg Endosc 1995;47:257–262.

    Google Scholar 

  5. Hunter JG. Laparoscopic transcystic common bile duct exploration. AmJ Surg 1992;163:53–58.

    Article  CAS  Google Scholar 

  6. Soper NJ, Dunnegan DL. Routine versus selective intra-operative cholangiography during laparoscopic cholecystectomy. World J Surg 1992;16:1133–1140.

    Article  PubMed  CAS  Google Scholar 

  7. White TT, Hart MJ. Cholangiography and small duct injury. AmJ Surg 1985;149:640–644.

    Article  CAS  Google Scholar 

  8. Barkam JS, Fried GM, Barkam AN, Sigman HH, Hinchey EJ, Garzon J, Wexler MJ, Meakins JL. Cholecystectomy without operative cholangiography. Ann Surg 1993;218:371–379.

    Article  Google Scholar 

  9. Haner-Jensen M, Karesen R, Nygaard K, Solheim K, Amile EJB, Havig O, Rosseland AR. Prospective randomized study of routine intraoperative cholangiography during open cholecystectomy: Long-term follow-up and multivariate analysis of predictors of choledocholithiasis. Surgery 1993; 113:318–323.

    Google Scholar 

  10. Morris JB, Margotis R, Rosato EE. Safe laparoscopic cholecystectomy without intraoperative cholangiography. Surg Laparosc Endosc 1993;3:17–20.

    PubMed  CAS  Google Scholar 

  11. Teffey SA, Soper NJ, Middleton WD, Balfe DM, Brink JA, Strasberg SM, Callery MP. Imaging of the common bile duct during laparoscopic cholecystectomy: Sonography versus videofluoroscopic cholangiography. Am J Roentgenol 1995; 165:847–851.

    Google Scholar 

  12. Pietrabissa A, Di Candio G, Giulianotti PC, Shimi SM, Cuschieri A, Mosca E. Comparative evaluation of contact ultrasonography and transcystic cholangiography during laparoscopic cholecystectomy: A prospective study. Arch Surg 1995;130:11 I0–1114.

    Google Scholar 

  13. Flowers JL, Zucker KA, Graham SM, Scovill WA, Imbembo AL, Bailey RW. Laparoscopic cholangiography: Results and indications. Ann Surg 1992;215:209–215.

    Article  PubMed  CAS  Google Scholar 

  14. Stiegmann GV, Soper NJ, Filipi CJ, McIntyre RC, Callery MP, Cordova JE. Laparoscopic ultrasonography as compared with static or dynamic cholangiography at laparoscopic cholecystectomy. Surg Endosc 1995;9:1269–1273.

    Article  PubMed  CAS  Google Scholar 

  15. Stiegmann GV, McIntyre RC, Pearlman NW. Laparoscopic intracorporeal ultrasound. Surg Endosc 1994;8:167–172.

    Article  PubMed  CAS  Google Scholar 

  16. Orda R, SayfanJ, Levy Y. Routine laparoscopic ultrasonography in biliary surgery. A preliminary experience. Surg Endosc 1994;8:1239–1242.

    Article  PubMed  CAS  Google Scholar 

  17. Machi J, Sigel B, Zaren HA, Schwartz J, Hosokawa T, Kita-mura H, Koleck V. Technique of ultrasound examination during laparoscopic cholecystectomy. Surg Endosc 1993;7:544–549.

    Article  PubMed  CAS  Google Scholar 

  18. Rothlin MA, Schlumpf R, Largiader E. Laparoscopic sonography: An alternative to routine intraoperative cholangiograplay? Arch Surg 1994;129:694–700.

    PubMed  CAS  Google Scholar 

  19. John TG, Banting SW, Pye S, Paterson-Brown S, Garden OJ. Preliminary experience with intracorporeal laparoscopic ultrasonography using a sector scanning probe. Surg Endosc 1994;8:1176–1181.

    Article  PubMed  CAS  Google Scholar 

  20. Yamamoto M, Stiegmann GV, Durham J, Berguer R, Oba Y, Fujiyama Y, Mclntyre RC. Laparoscopy-guided intracorporeal ultrasound accurately delineates hepatohiliary anatomy. Surg Endosc 1993;7:325–330.

    Article  PubMed  CAS  Google Scholar 

  21. Yamashita Y, Kurohiji T, Hayashi J, Kimitsuki H, Hiram M, Kakegawa T. Intraoperative ultrasonography during laparoscopic cholecystectomy. Surg Laparosc Endosc 1993;3:167–171.

    PubMed  CAS  Google Scholar 

  22. Goletti O, Buccianti P, Decanini L, et al. Intraoperative sonography of biliary tree during laparoscopic cholecystectomy. Surg Laparosc Endosc 1994;4:9–12.

    PubMed  CAS  Google Scholar 

  23. Santambrogio R, Bianchi P, Opocher E, Mantovani A, Schu-bert L, Ghelma F, Panzera M, Verga M, Spina GP. Intraoperative ultrasonography (IOUS) during laparoscopic cholecystectomy. Surg Endosc 1996;10:622–627.

    Article  Google Scholar 

  24. Callery MP, Strasberg SM, Doherty GM, Soper NJ, Norton JA. Staging laparoscopy with laparoscopic ultrasonography: Optimizing resectability in hepatobiliary and pancreatic malignancy. J Am Coil Surg 1997;185:33–39.

    CAS  Google Scholar 

  25. Soper NJ, Jones DB. Laparoscopic cholecystectomy. In Brooks DC, ed. Current Techniques in Laparoscopy, 2nd ed. Philadelphia: Current Medicine, 1995, pp 2–24.

    Google Scholar 

  26. Jacldmowicz JJ. Review: Intraoperative ultrasonography during minimal access surgery. J R Coll Surg Edinb 1993;38:231–238.

    Google Scholar 

  27. Strasberg SM, Herd M, -Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101–125.

    PubMed  CAS  Google Scholar 

  28. Laing FC. Commonly encountered artifacts in clinical ultrasound. Semin Ultrasound 1983;4:27–43.

    Google Scholar 

  29. Grier JF, Cohen SW, Grafton WD, Gholson CE. Acute suppurative cholangids associated with choledochal sludge. Am J Gastroenterol 1994;89:617–619.

    PubMed  CAS  Google Scholar 

  30. Lee SP, Nicholls JF, Parks HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med 1992; 12:656–662.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, and the Washington University Institute for Minimally Invasive Surgery, St. Louis, Mo

    Justin S. Wu M.D., Deannia L. Dunnegan R.N. & Nathaniel J. Soper M.D., EA.C.S.

Authors
  1. Justin S. Wu M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deannia L. Dunnegan R.N.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nathaniel J. Soper M.D., EA.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by the Washington University Institute for Minimally Invasive Surgery as fimded by a grant from Ethicon-Endosurgery, Inc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wu, J.S., Dunnegan, D.L. & Soper, N.J. The utility of intracorporeal ultrasonography for screening of the bile duct during laparoscopic cholecystectomy. J Gastrointest Surg 2, 50–60 (1998). https://doi.org/10.1016/S1091-255X(98)80103-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1091-255X(98)80103-0

Keywords

Search

Navigation