Intraoperative echography in biliary tract surgery. A comparative study of intraoperative echography/cholangiography in the detection of calculi in the common bile duct.

Abstract

We report 3 years of experience with operative ultrasonography on 200 patients who underwent cholecystectomy for biliary lithiasis. Intraoperative ultrasonography and intraoperative cholangiography were performed on all of these patients and compared with the operative findings. The diagnostic accuracy of sonography was 98% and that of cholangiography 96% in the whole patient group. The predictive value of a positive ultrasonography was 92.5% while that of a positive cholangiogram was lower at 81.5%. In 32 patients who underwent surgical exploration of the common duct the use of these two intraoperative screening tests together led to a positive common duct exploration in 75% of the patients. Overall morbidity in this series was 4.8% against 12.8% (common duct exploration) and retained stones following duct exploration were present in 1 patient in intra-hepatic situation. The overall mortality rate of the entire patient group was 0%. Operative ultrasonography of the biliary tract as a screening procedure is a reliable method, a possible substitute for operative cholangiography, but perhaps in reality both methods are complementary.