title: Comparative evaluation of contact ultrasonography and transcystic cholangiography during laparoscopic cholecystectomy: a prospective study.
abstract: BACKGROUND
  The role of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is controversial. While many advocate its routine use, others argue for a selective approach. Recent reports showed laparoscopic contact ultrasonography (LCU) as a viable alternative to IOC. However, no prospective data were available to compare the accuracy, efficacy, and safety of the two diagnostic procedures.
  
  
  OBJECTIVE
  To evaluate the benefits and disadvantages of LCU and IOC during LC.
  
  
  METHODS
  Seventy-eight patients who underwent LC at Pisa (Italy) and Dundee (Scotland) university hospitals were entered in a prospective data registry. Details of operative technique and results of LCU and IOC were analyzed by reviewing videotape recordings of each procedure.
  
  
  RESULTS
  Laparoscopic cholecystectomy was achieved in 73 patients, with five requiring conversion to the open procedure. The success rate of IOC was 90% (64/71). Performance of IOC demanded more than twice the time needed for LCU. Eleven percent (8/71) of cholangiograms were abnormal, with a false-positive rate of 1% (1/71). Laparoscopic contact ultrasonography detected all four instances of unsuspected ductal stones but none of the three cases of anomalous biliary anatomy. Clinically relevant incidental findings were picked up by LCU in six patients.
  
  
  CONCLUSIONS
  Laparoscopic contact ultrasonography proved to be extremely accurate in the detection of ductal stones but less reliable in the disclosure of anomalous biliary anatomy. The essential role of IOC in providing a clear spatial display of the biliary tract was confirmed. Since the two procedures are complementary, their combined use is advisable in difficult LC to avoid retained common bile duct stones and prevent iatrogenic complications.
authors.affiliation: Istituto di Chirurgia Generale e Spermentale, Università di Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pietrabissa
authors.forename: G
authors.initials: G
authors.lastname: Di Candio
authors.forename: P C
authors.initials: PC
authors.lastname: Giulianotti
authors.forename: S M
authors.initials: SM
authors.lastname: Shimi
authors.forename: A
authors.initials: A
authors.lastname: Cuschieri
authors.forename: F
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000328:Adult; D000368:Aged; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D015529:Choledochal Cyst / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000175:diagnosis* / Q000601:surgery*; D004067:Digestive System Neoplasms / Q000175:diagnosis; D005069:Evaluation Studies as Topic; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods*