Evaluation of the biliary tree during laparoscopic cholecystectomy: Laparoscopic ultrasound versus intraoperative cholangiography. Prospective study: 150 cases.

From November 1994 to March 1996, 150 patients treated by laparoscopic cholecystectomy were included in a prospective study, in order to compare intraoperative cholangiography and laparoscopic ultrasound. The biliary tree was successively explored by the two methods in the systematic detection of common bile duct stones. The feasability of laparoscopic ultrasound was 100 per cent. Cholangiography was performed in only 125 cases (83 per cent). The duration of the laparoscopic ultrasound exam was significantly shorter (11.6 vs 17.6 minutes, p = 0.0001). In this study, common bile duct stones were found in 14 cases (9 per cent). The detection rates with laparoscopic ultrasound and intraoperative cholangiography were similar. For laparoscopic ultrasound, sensitivity was 80 per cent and specificity was 99 per cent, versus 78 per cent and 97 per cent for cholangiography, respectively. The combination of the 2 examinations had a 100 per cent sensitivity and specificity. Laparoscopic ultrasound failed to recognize the intrapancreatic part of the bile duct (25 cases: 17 per cent), did not show anatomical abnomalies detected by cholangiography, but detected unsuspected digestive lesions. Laparoscopic ultrasound is safe repeatable, and non invasive, but a learning curve is necessary to increase this efficacy. Comparison of cost must be evaluated.