title: Laparoscopic ultrasonography is a complement to cholangiography for the detection of choledocholithiasis at laparoscopic cholecystectomy.
abstract: BACKGROUND
  Intraoperative cholangiography and laparoscopic ultrasonography are both used in the detection of common bile duct stones at laparoscopic cholecystectomy. The aim of this prospective study was to determine whether laparoscopic ultrasonography has an alternative or a complementary role with respect to cholangiography in achieving this end.
  
  
  METHODS
  The biliary trees of 900 patients undergoing laparoscopic cholecystectomy were examined routinely by the two methods. The diagnostic power of each investigation and of the two techniques in combination was evaluated. The statistical non-random concordance between the two methods was also determined.
  
  
  RESULTS
  Laparoscopic ultrasonography was performed in all 900 patients. Cholangiography was performed in 762 (85 per cent). The mean (range) duration was 9.8 (4-21) min for laparoscopic ultrasonography and 17.6 (7-42) min for cholangiography. For the detection of common bile duct stones, with a kappa coefficient of 0.57 (95 per cent confidence interval (c.i.) 0.43 to 0.71), the non-random concordance between the two methods was considered to be fair to good. The sensitivity of laparoscopic ultrasonography was 0.80 (95 per cent c.i. 0.65 to 0.91) and its specificity was 0.99 (95 per cent c.i. 0.98 to 1.00). The respective values for cholangiography were 0.75 (95 per cent c.i. 0.59 to 0.87) and 0.99 (95 per cent c.i. 0.98 to 1.00). The examinations combined had a sensitivity of 0.95 (95 per cent c.i. 0.86 to 0.99) and a specificity of 0.98 (95 per cent c.i. 0.96 to 1.00).
  
  
  CONCLUSIONS
  Laparoscopic ultrasonography and intraoperative cholangiography are complementary, as the combination of both methods maximizes the intraoperative detection of choledocholithiasis.
authors.affiliation: Department of Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Catheline
authors.forename: R
authors.initials: R
authors.lastname: Turner
authors.forename: J
authors.initials: J
authors.lastname: Paries
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography / Q000379:methods* / Q000592:standards; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography