World Journal of Laparoscopic Surgery

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  17 (2024)
Volume  16 (2023)
Volume  15 (2022)
Volume  14 (2021)
Volume  13 (2020)
Volume  12 (2019)
Volume  11 (2018)
Volume  10 (2017)
Volume  9 (2016)
Volume  8 (2015)
Volume  7 (2014)
Volume  6 (2013)
Volume  5 (2012)
Volume  4 (2011)
Volume  3 (2010)
Volume  2 (2009)
Volume  1 (2008)
Related articles

VOLUME 14 , ISSUE 2 ( May-August, 2021 ) > List of Articles

Original Article

Comparison between Laparoscopic Ultrasound and Intraoperative Cholangiogram in Detection of Common Bile Duct Stones during Laparoscopic Cholecystectomy for Cholelithiasis: A Prospective Study

Gouda Ellabban, Mohamed Shams, Mostafa Abdel-Raheem, Hamdy Shaban

Keywords : Diagnostic accuracy, Intraoperative cholangiography, Laparoscopic cholecystectomy

Citation Information : Ellabban G, Shams M, Abdel-Raheem M, Shaban H. Comparison between Laparoscopic Ultrasound and Intraoperative Cholangiogram in Detection of Common Bile Duct Stones during Laparoscopic Cholecystectomy for Cholelithiasis: A Prospective Study. World J Lap Surg 2021; 14 (2):69-74.

DOI: 10.5005/jp-journals-10033-1449

License: CC BY-NC 4.0

Published Online: 19-08-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is valuable in the detection of biliary abnormalities. In this study, we aimed to investigate the diagnostic accuracy of IOC during LC for the detection of anatomic variations of the biliary system, as well as the visualization ability of IOC on determining the normal anatomy of the biliary tree. Materials and methods: This cross-sectional study was conducted on patients who were presented to the surgery outpatient clinic and were scheduled for elective LC for symptomatic cholelithiasis. Patients underwent intraoperative laparoscopic ultrasound (LUS) before the dissection of Calot's triangle and IOC video fluoroscopy examination of the extrahepatic biliary tree. Results: Our study enrolled 53 patients. No intraoperative complications occurred in all enrolled patients. LUS was successful in all 53 (100%) cases, while IOC was successful in 50 (94.3%) cases. IOC had accuracy rate of 100% (50 patients) in defining biliary ducts at the porta hepatis compared to 84.91% (45 patients) for LUS with a failure rate of 15.09% (p = 0.60). Concerning stones detection, LUS accuracy indexes were as follows: sensitivity = 80%; specificity = 95.83%; positive predictive value (PPV) = 66.67%; negative predictive value (NPV) = 97.87% 99; and diagnostic odds ratio (DOR) = 92. IOC accuracy indexes were as follows: sensitivity = 80%; specificity = 93.33%; PPV = 57.14%; NPV = 90%; and DOR = 56. Conclusion: The results of the current study encourage using IOC as an effective, accurate, feasible, and safe technique to visualize the biliary tree while performing LC.

HTML PDF Share
  1. Santambrogio R, Montorsi M, Bianchi P, et al. Common bile duct exploration and laparoscopic cholecystectomy: role of intraoperative ultrasonography. J Am Coll Surg 1997;185(1):40–48. DOI: 10.1016/s1072-7515(97)00013-6.
  2. Giger U, Michel JM, Vonlanthen R, et al. Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome. Langenbeck's Arch Surg 2005;390(5):373–380. DOI: 10.1007/s00423-004-0509-4.
  3. Dubois F, Icard P, Berthelot G, et al. Coelioscopic cholecystectomy. Ann Surg 1990;211(1):60–62. DOI: 10.1097/00000658-199001000-00010.
  4. Pesce A, Piccolo G, La Greca G, et al. Utility of fluorescent cholangiography during laparoscopic cholecystectomy: a systematic review. World J Gastroenterol 2015;21(25):7877–7883. DOI: 10.3748/wjg.v21.i25.7877.
  5. Ding GQ, Cai W, Qin MF. Is intraoperative cholangiography necessary during laparoscopic cholecystectomy for cholelithiasis? World J Gastroenterol 2015;21(7):2147–2151. DOI: 10.3748/wjg.v21.i7.2147.
  6. Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 2006;93(2):158–168. DOI: 10.1002/bjs.5266.
  7. Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003;237(4):460–469. DOI: 10.1097/01.SLA.0000060680.92690.E9.
  8. Hublet A, Dili A, Lemaire J, et al. Laparoscopic ultrasonography as a good alternative to intraoperative cholangiography (IOC) during laparoscopic cholecystectomy: results of prospective study. Acta Chir Belg 109(3):312–316. DOI: 10.1080/00015458.2009.11680431.
  9. Halawani HM, Tamim H, Khalifeh F, et al. Impact of intraoperative cholangiography on postoperative morbidity and readmission: analysis of the NSQIP database. Surg Endosc 2016;30(12):5395–5403. DOI: 10.1007/s00464-016-4896-8.
  10. Martin B, Ong EGP. Selective intraoperative cholangiography during laparoscopic cholecystectomy in children is justified. J Pediatr Surg 2018;53(2):270–273. DOI: 10.1016/j.jpedsurg.2017.11.017.
  11. Giulea C, Enciu O, Bîrcâ T, et al. Selective intraoperative cholangiography in laparoscopic cholecystectomy. Chirurgia 2016;111(1):26–32. PMID: 10917468.
  12. Flum DR. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 2003;289(13):1639–1644. DOI: 10.1001/jama.289.13.1639.
  13. Urbach DR. Rate of elective cholecystectomy and the incidence of severe gallstone disease. Can Med Assoc J 2005;172(8):1015–1019. DOI: 10.1503/cmaj.1041363.
  14. Machi J, Tateishi T, Oishi AJ, et al. Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: review of the literature and a comparison with open intraoperative ultrasonography. J Am Coll Surg 1999;188(4):360–367. DOI: 10.1016/s1072-7515(98)00313-5.
  15. Jamal K, Smith H, Ratnasingham K, et al. Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones. Ann R Coll Surg Engl 2016;98(04):244–249. DOI: 10.1308/rcsann.2016.0068.
  16. Aziz O, Ashrafian H, Jones C, et al. Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy: a meta-analysis of diagnostic accuracy. Int J Surg 2014;12(7):712–719. DOI: 10.1016/j.ijsu.2014.05.038.
  17. Li J-W, Feng B, Wu L, et al. Intraoperative cholangiography in combination with laparoscopic ultrasonography for the detection of occult choledocholithiasis. Med Sci Monit 2009;15(9):MT126–MT130. PMID: 19721408
  18. Machi J, Oishi AJ, Tajiri T, et al. Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy. Surg Endosc 2007;21(2): 270–274. DOI: 10.1007/s00464-005-0817-y.
  19. Rhodes M, Nathanson L, O'rourke N, et al. Laparoscopic exploration of the common bile duct: lessons learned from 129 consecutive cases. Br J Surg 1995;82(5):666–668. DOI: 10.1002/bjs.1800820533.
  20. Hainsworth PJ, Rhodes M, Gompertz RHK, et al. Imaging of the common bile duct in patients undergoing laparoscopic cholecystectomy. Gut 1994;35(7):991–995. DOI: 10.1136/gut.35.7.991. Available from: http://gut.bmj.com/.
  21. Ganguli S, Kruskal JB, Brennan DD, et al. Intraoperative laparoscopic ultrasound, vol. 1. In: Ultrasound clinics. 2006. p. 547–557.
  22. Ford JA, Soop M, Du J, et al. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 2012;99(2):160–167. DOI: 10.1002/bjs.7809.
  23. Serralta Serra A, Planells Roig M, Bueno Lledo J, et al. The learning curve in ambulatory laparoscopic cholecystectomy. Surg Laparosc Endosc Percutaneous Tech 2002;12(5):320–324. DOI: 10.1097/00129689-200210000-00003.
  24. The Southern Surgeons Club, Moore MJ, Bennett CL. The learning curve for laparoscopic cholecystectomy. Am J Surg 1995;170(1):55–59. DOI: 10.1016/s0002-9610(99)80252-9.
  25. Polat FR, Abci I, Coskun I, et al. The importance of intraoperative cholangiography during laparoscopic cholecystectomy. JSLS: J Soc Laparoendosc Surg 2000;4(2):103–107. PMID: 10917115; PMCID: PMC3015375
  26. Darrien JH, Connor K, Janeczko A, et al. The surgical management of concomitant gallbladder and common bile duct stones. HPB Surg 2015;2015:165068. DOI: 10.1155/2015/165068.
  27. Ghazal AH, Sorour MA, El-Riwini M, et al. Single-step treatment of gall bladder and bile duct stones: a combined endoscopic-laparoscopic technique. Int J Surg 2009;7(4):338–346. DOI: 10.1016/j.ijsu.2009.05.005.
  28. Hicken NF, McAllister AJ. Operative cholangiography as an aid in reducing the incidence of “overlooked” common bile duct stones: a study of 1,293 choledocholithotomies. Surgery1964;55(6):753–758. DOI: https://doi.org/10.26611/106837
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.