Assessment of common bile duct using laparoscopic ultrasound during laparoscopic cholecystectomy.

BACKGROUND: Several reports have shown that laparoscopic ultrasound (LUS) examination of the bile duct is promising and suggest it as a primary method for bile duct imaging during laparoscopic cholecystectomy (LC). This study was designed to evaluate the feasibility of LUS during LC, and the occurrence rate of common bile duct (CBD) stones during LC.

MATERIALS AND METHODS: One hundred and fifteen consecutive patients with gallstones were enrolled into this study. LUS was used to assess the CBD routinely during LC, which was successfully performed in 112 cases. Choledocholithiasis was rated before LC as being of low, intermediate, or high probability on the basis of clinical, laboratory, and/or imaging findings (Cotton criteria). Duct calculi were defined as echogenic material within the CBD, which cast discrete acoustic shadows. Sludge was defined as mobile or floating low-amplitude echogenic material without discrete acoustic shadowing.

RESULTS: The CBD could be evaluated in 112 of 115 LC (97.4%) patients (72 females and 40 males). The mean age was 54+/-16 years old. The occurrence rate of CBD stones in the low-risk group was 7%, that in the intermediate group was 36.4%, and the high-risk group was 78.9%. The overall incidence of CBD stones was 25.0%.

CONCLUSIONS: With increasing experience, LUS can become the routine method for evaluating the bile duct during LC. A more aggressive preoperative evaluation of CBD is mandated in the intermediate and high-risk groups of patients suspected of having CBD stones.