title: Assuring complete laparoscopic clearance of the bile duct.
abstract: BACKGROUND
  The aim of this study was to evaluate and compare the use of choledochoscopy, cholangiography, and laparoscopic ultrasound in ensuring bile duct clearance and the prevention of missed stones after laparoscopic exploration.
  
  
  METHODS
  Operative details of 439 consecutive patients who underwent laparoscopic bile duct exploration between April 1994 and February 2005 were collected prospectively. Thirty-six conversions, 8 failures, and 8 patients who had a biliary enteric drainage procedure were excluded. Follow-up was by postal questionnaire or via their GP if there was no response.
  
  
  RESULTS
  One-year follow-up was complete in 95%. Patients underwent 253 transductal, 94 transcystic, and 29 radiological explorations. Laparoscopic ultrasound prompted immediate re-exploration of the bile ducts in six patients for stones missed by choledochoscopy. About 3.4% of patients presented with a missed stone within 1 year of surgery. The negative predictive values of choledochoscopy alone, choledochoscopy followed by postexploratory cholangiography and choledochoscopy followed by postexploratory laparoscopic ultrasound have been found to be 94.6%, 97.9%, and 97.4%, respectively.
  
  
  CONCLUSIONS
  Double checking duct clearance with laparoscopic ultrasound after choledochoscopy is worthwhile, whereas cholangiography is not.
authors.affiliation: Department of Surgery, Southmead Hospital, Bristol, United Kingdom. hamish.noble@nhs.net
authors.forename: Hamish
authors.initials: H
authors.lastname: Noble
authors.forename: Sally
authors.initials: S
authors.lastname: Norton
authors.forename: Michael
authors.initials: M
authors.lastname: Thompson
mesh_terms: D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D011446:Prospective Studies; D011859:Radiography; D012074:Remission Induction; D014463:Ultrasonography