Common bile duct exploration and laparoscopic cholecystectomy

Role of intraoperative ultrasonography

Roberto Santambrogio, Marco Montorsi, Paolo Bianchi, Enrico Opocher, Maurizio Verga, Mario Panzera, Felice Cosentino

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: In October 1993, to detect associated common bile duct (CBD) stones, we started an evaluation program of patients with symptomatic cholelithiasis who were candidates for laparoscopic cholecystectomy. Study Design: We used a standard preoperative algorithm and a laparoscopic ultrasonographic (LUS) examination. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was reserved for high-risk patients for CBD stones. Laparoscopic ultrasonographic examination during cholecystectomy was routinely performed to identify stones unsuspected preoperatively. Two- hundred-sixteen patients with symptomatic cholelithiasis were included in the study; 177 patients (82%) were at low risk 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 sphincterotomy. Results: In all patients, the main intra- and extrahepatic ducts were well documented by LUS, but in eight cases the distal tract of the CBD was not well-visualized. In eight parents, small stones were found in the CBD. A subsequent peroperative cholangiography or CBD exploration confirmed the diagnosis. In one patient, both LUS and cholangiography suspected a small stone; the CBD exploration did not confirm it (false positive). In two patients a small stone in the CBD was found during the followup period (two false negatives). An endoscopic sphincterotomy solved the problem. Conclusions: Laparoscopic ultrasonographic examination may be a real alternative to cholangiography during laparoscopic cholecystectomy: this may be reserved for selected instances on the basis of LUS findings. On the other hand, considerable ultrasonographic experience is required for LUS to be performed successfully.

Original languageEnglish
Pages (from-to)40-48
Number of pages9
JournalJournal of the American College of Surgeons
Volume185
Issue number1
DOIs
Publication statusPublished - 1997

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Laparoscopic Cholecystectomy
Common Bile Duct
Ultrasonography
Cholangiography
Endoscopic Sphincterotomy
Cholelithiasis
Endoscopic Retrograde Cholangiopancreatography
Choledocholithiasis
Program Evaluation
Cholecystectomy
Parents

ASJC Scopus subject areas

  • Surgery

Cite this

Common bile duct exploration and laparoscopic cholecystectomy : Role of intraoperative ultrasonography. / Santambrogio, Roberto; Montorsi, Marco; Bianchi, Paolo; Opocher, Enrico; Verga, Maurizio; Panzera, Mario; Cosentino, Felice.

In: Journal of the American College of Surgeons, Vol. 185, No. 1, 1997, p. 40-48.

Research output: Contribution to journalArticle

Santambrogio, Roberto ; Montorsi, Marco ; Bianchi, Paolo ; Opocher, Enrico ; Verga, Maurizio ; Panzera, Mario ; Cosentino, Felice. / Common bile duct exploration and laparoscopic cholecystectomy : Role of intraoperative ultrasonography. In: Journal of the American College of Surgeons. 1997 ; Vol. 185, No. 1. pp. 40-48.
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abstract = "Background: In October 1993, to detect associated common bile duct (CBD) stones, we started an evaluation program of patients with symptomatic cholelithiasis who were candidates for laparoscopic cholecystectomy. Study Design: We used a standard preoperative algorithm and a laparoscopic ultrasonographic (LUS) examination. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was reserved for high-risk patients for CBD stones. Laparoscopic ultrasonographic examination during cholecystectomy was routinely performed to identify stones unsuspected preoperatively. Two- hundred-sixteen patients with symptomatic cholelithiasis were included in the study; 177 patients (82{\%}) were at low risk 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 sphincterotomy. Results: In all patients, the main intra- and extrahepatic ducts were well documented by LUS, but in eight cases the distal tract of the CBD was not well-visualized. In eight parents, small stones were found in the CBD. A subsequent peroperative cholangiography or CBD exploration confirmed the diagnosis. In one patient, both LUS and cholangiography suspected a small stone; the CBD exploration did not confirm it (false positive). In two patients a small stone in the CBD was found during the followup period (two false negatives). An endoscopic sphincterotomy solved the problem. Conclusions: Laparoscopic ultrasonographic examination may be a real alternative to cholangiography during laparoscopic cholecystectomy: this may be reserved for selected instances on the basis of LUS findings. On the other hand, considerable ultrasonographic experience is required for LUS to be performed successfully.",
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