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Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy

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Abstract

Background

The use of intraoperative cholangiography (IOC), routinely rather than selectively, during laparoscopic cholecystectomy (LC) is controversial. Recent findings have shown laparoscopic ultrasound (LUS) to be safe, quick, and effective not only for screening of the bile duct for stones, but also for evaluating the biliary anatomy. This study aimed to evaluate, on the basis of the LC outcome and the cost of LUS and IOC, whether and how much the routine use of LUS would be able to reduce the need for IOC.

Methods

During LC, LUS was used routinely to screen the bile duct for stones and to evaluate the biliary anatomy, whereas IOC was used selectively only when LUS was unsatisfactory or unsuccessful.

Results

For 193 (96.5%) of 200 patients, LUS was completed successfully, whereas IOC was needed for 7 patients (3.5%). Bile duct stones were identified in 20 patients (10%). For the detection of bile duct stones, LUS yielded 19 true-positive, 175 true-negative, 0 false-positive, and 1 false-negative results. It had a sensitivity of 95%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 99.4%. The postoperative complications included bile leaks from the liver bed in two patients and a retained bile duct stone in one patient. If IOC had been used selectively in a traditional manner on the basis of preoperative risk factors, IOC would have been needed for 77 patients (38.5%). The total cost of LUS plus IOC for the current 200 patients was $26,256. The total estimated cost of selective IOC, if it had been performed for the 77 patients, would have been $31,416.

Conclusions

Routine LUS accurately diagnosed bile duct stones and significantly reduced the need for selective IOC from a potential 38.5% to an actual 3.5% without adversely affecting the outcome of the LC or increasing the overall cost. The routine use of LUS during LC is accurate and cost effective.

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References

  1. Biffl WL, Moore EE, Offner PJ, Franciose RJ, Burch JM (2001) Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy. J Am Coll Surg 193: 272–280

    Article  CAS  Google Scholar 

  2. Birth M, Carroll BJ, Delinikolas K, Eichler M, Weiser HF (1996) Recognition of laparoscopic bile duct injuries by intraoperative ultrasonography. Surg Endosc 10: 794–797

    Article  CAS  Google Scholar 

  3. Birth M, Lossin P, Brugmans F, Weiser HF (2000) Vascular injuries within the hepatoduodenal ligament: recognition by laparoscopic color Doppler ultrasound. Surg Endosc 14: 246–249

    Article  CAS  Google Scholar 

  4. Debru E, Dawson A, Leibman S, Richardson M, Glen L, Hollinshead J, Falk GL (2005) Does routine intraoperative cholangiography prevent bile duct transection? Surg Endosc 19: 589–593

    Article  CAS  Google Scholar 

  5. Falcone RA Jr, Fegelman EJ, Nussbaum MS, Brown DL, Bebbe TM, Merhar GL, Johannigman JA, Luchette FA, Davis K Jr, Hurst JM (1999) A prospective comparison of laparoscopic ultrasound vs intraoperative cholangiogram during laparoscopic cholecystectomy. Surg Endosc 13: 784–788

    Article  Google Scholar 

  6. Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner Hj, Edis A (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229: 449–457

    Article  CAS  Google Scholar 

  7. Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289: 1639–1644

    Article  Google Scholar 

  8. Flum DR, Flowers C, Veenstra DL (2003) A cost-effective analysis of intraoperative cholangiography in the prevention of bile duct injury during laparoscopic cholecystectomy. J Am Coll Surg 196: 385–393

    Article  Google Scholar 

  9. Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP (2001) Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 136: 1287–1292

    Article  CAS  Google Scholar 

  10. Halpin VJ, Dunnegan D, Soper NJ (2002) Laparoscopic intracorporeal ultrasound vs fluoroscopic intraoperative cholangiography: after the learning curve. Surg Endosc 16: 336–341

    Article  CAS  Google Scholar 

  11. Lorimer JW (2004) Results of cholecystectomy without intraoperative cholangiography. Can J Surg 47: 343–346

    PubMed  PubMed Central  Google Scholar 

  12. Machi J, Oishi AJ, Uchida S, Furutmoto NL, Oishi RH (2000) A simple laparoscopic ultrasound technique for prevention of bile duct injuries. J Laparoendosc Adv Surg Techn 10: 165–168

    Article  CAS  Google Scholar 

  13. Machi J, Tateishi T, Oishi AJ, Furumoto NL, Oishi RH, Uchida S, Sigel B (1999) Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: review of the literature and a comparison with open intraoperative ultrasonography. J Am Coll Surg 188: 360–367

    Article  CAS  Google Scholar 

  14. Menack MJ, Arregui ME (2000) Laparoscopic sonography of the biliary tree and pancreas. Surg Clin North Am 80: 1151–1170

    Article  CAS  Google Scholar 

  15. Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187: 475–481

    Article  Google Scholar 

  16. Ohtani T, Kawai C, Shirai Y, Kawakami K, Yoshida K, Hatakeyama K (1997) Intraoperative ultrasonography versus cholangiography during laparoscopic cholecystectomy: a prospective comparative study. J Am Coll Surg 185: 274–282

    Article  CAS  Google Scholar 

  17. Onders RP, Hallowell PT (2005) The era of ultrasonography during laparoscopic cholecystectomy. Am J Surg 189: 348–351

    Article  Google Scholar 

  18. Podnos YD, Gelfand DV, Dulkanchainun TS, Wilson SE, Cao S, Ji P, Ortiz JA, Imagawa DK (2001) Is intraoperative cholangiography during laparoscopic cholecystectomy cost effective? Am J Surg 182: 663–669

    Article  CAS  Google Scholar 

  19. Rothlin MA, Schob O, Schlumpf R, Largiader F (1996) Laparoscopic ultrasonography during cholecystectomy. Br J Surg 83: 1512–1516

    Article  CAS  Google Scholar 

  20. Siperstein A, Pearl J, Macho J, Hansen P, Gitomirsky A, Rogers S (1999) Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy. Surg Endosc 13: 113–117

    Article  CAS  Google Scholar 

  21. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180: 101–125

    CAS  PubMed  Google Scholar 

  22. Thornton DJA, Robertson A, Alexander DJ (2002) Laparoscopic cholecystectomy without operative cholangiography does not result in significant problems related to retained stones. Surg Endosc 16: 592–595

    Article  CAS  Google Scholar 

  23. Tomonaga T, Filipi CJ, Lowham A, Martinez T (1999) Laparoscopic intracorporeal ultrasound cystic duct length measurement: a new technique to prevent common bile duct injuries. Surg Endosc 13: 183–185

    Article  CAS  Google Scholar 

  24. Tranter SE, Thompson MH (2003) A prospective single-blinded controlled study comparing laparoscopic ultrasound of the common bile duct with operative cholangiography. Surg Endosc 17: 216–219

    Article  CAS  Google Scholar 

  25. Winslow ER, Soper NJ (2005) Intraoperative and laparoscopic ultrasound of biliary tract. In: Machi J, Staren ED (eds) Ultrasound for surgeons, 2nd ed. Lippincott Williams and Wilkins, Philadelphia, pp 289–313

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Hawaii and Kuakini Medical Center, 347 North Kuakini Street, Honolulu, Hawaii, 96817, USA

    J. Machi, A. J. Oishi, T. Tajiri, K. M. Murayama, N. L. Furumoto & R. H. Oishi

  2. 405 N. Kuakini Street, Suite 601, Honolulu, HI, 96817, USA

    J. Machi

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  1. J. Machi
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  2. A. J. Oishi
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  3. T. Tajiri
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  4. K. M. Murayama
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  5. N. L. Furumoto
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  6. R. H. Oishi
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Correspondence to J. Machi.

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Machi, J., Oishi, A.J., Tajiri, T. et al. Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy. Surg Endosc 21, 270–274 (2007). https://doi.org/10.1007/s00464-005-0817-y

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  • DOI: https://doi.org/10.1007/s00464-005-0817-y

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