The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study.
OBJECTIVE
Laparoscopic ultrasound (LUS) has been used for over 15 years to screen the bile duct (BD) for stones and to delineate anatomy during laparoscopic cholecystectomy (LC). LUS as a modality to prevent BD injury has not been investigated in a large series. This study evaluated the routine use of LUS to determine its effect on preventing BD injury.


METHODS
A multicenter retrospective study was performed by reviewing clinical outcome of LC in which LUS was used routinely.


RESULTS
In five centers, 1,381 patients underwent LC with LUS. LUS was successful to delineate and evaluate the BD in 1,352 patients (98.0%), although it was unsuccessful or incomplete in 29 patients (2.0%). LUS was considered remarkably valuable to safely complete LC, avoiding conversion to open, in 81 patients (5.9%). The use of intraoperative cholangiography (IOC) varied depending on centers; IOC was performed in 504 patients (36.5%). For screening of BD stones (which was positive in 151 patients, 10.9%), LUS had a false-positive result in two patients (0.1%) and a false-negative result in five patients (0.4%). There were retained BD stones in three patients (0.2%). There were minor bile leaks from the liver bed in three patients (0.2%). However, there were no other BD injuries including BD transection (0%). Retrospectively, IOC was deemed necessary in 25 patients (1.8%) to complete LC in spite of routine LUS.


CONCLUSIONS
LUS can be performed successfully to delineate BD anatomy in the majority of patients. The routine use of LUS during LC has obviated major BD injury, compared to the reported rate (1 out of 200-400 LCs). LUS improves the safety of LC by clarifying anatomy and decreasing BD injury.
Machi
Junji
J
Department of Surgery, University of Hawaii and Kuakini Medical Center, 405 N. Kuakini St., Suite 601, Honolulu, HI 96817, USA. junji@hawaii.edu
Johnson
James O
JO
Deziel
Daniel J
DJ
Soper
Nathaniel J
NJ
Berber
Eren
E
Siperstein
Allan
A
Hata
Masaki
M
Patel
Anand
A
Singh
Kirpal
K
Arregui
Maurice E
ME
D001649:Bile Duct Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D015331:Cohort Studies; D019160:Endosonography; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome