Comparison of cholangiography and ultrasonography in the operative screening of the common bile duct

Sigel, Bernard; Coelho, Júlio Cezar Uili; Nyhus, Lloyd M.; Donahue, Philip E.; Velasco, Josè M.; Spigos, Dimitrios G.

doi:10.1007/bf01657676

Cited by 16 publications

(10 citation statements)

References 6 publications

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“…Compared to operative cholangiography, OUS demonstrates equal or superior accuracy [5,6,20]. In our study, the predictability of a positive test of OUS was significantly higher, likely contributing to the high positive common bile duct exploration rate.…”

Section: Discussionmentioning

confidence: 63%

Operative ultrasonography during hepatobiliary and pancreatic surgery

et al. 1993

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On the basis of our experience with operative ultrasonography during hepatobiliary and pancreatic surgery, its indications, benefits, and disadvantages are summarized. High-resolution operative ultrasound scanning of the liver, biliary tract, and pancreas was performed during 357, 735, and 242 operations, respectively. The benefits of operative ultrasonography were categorized as acquisition of diagnostic information otherwise not available, replacement for or complement to operative radiography, and guidance of surgical procedures. Operative ultrasonography provided beneficial information during 73 of 82 hepatic operations (89.0%), 57 of 69 noncalculous biliary operations (82.6%), and 177 of 242 pancreatic operations (73.1%). Operative ultrasonography was significantly superior (sensitivity 93.3%) to other screening tests for diagnosing liver metastasis from colorectal carcinoma evaluated in 189 patients, and it detected previously unrecognized metastatic tumors in 18 patients (9.5%). For screening common bile duct calculi during 666 operations, operative ultrasonography and operative cholangiography were comparable in all indices of accuracy except for a higher predictability of a positive test of operative ultrasonography (94.8% versus 71.7%). For diagnosing portal vein invasion of pancreatic carcinoma, operative ultrasonography provided better overall accuracy than preoperative studies (89.7% versus 64.1%). On the basis of operative ultrasound findings, previously planned surgical procedures were altered in 32 of 82 hepatic operations (39.0%) and 24 of 145 pancreatic operations for chronic pancreatitis (16.6%). Operative ultrasound guidance of various surgical procedures was performed during 88 hepatic and 84 pancreatic operations, including 40 ultrasound-guided hepatectomies and 42 pancreatotomies. Operative ultrasonography has a number of advantages, such as safety and speed in performance, wide application, high diagnostic accuracy, and ability of guiding procedures. Its disadvantages are the limitation of the fields of view in certain applications, the need for special equipment, and a slow learning curve.

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Section: Discussionmentioning

confidence: 63%

Operative ultrasonography during hepatobiliary and pancreatic surgery

et al. 1993

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“…The main purpose of these operative diagnostic procedures, in the setting of verified or suspected cholelithiasis, is to detect common bile duct disease that would not otherwise be suspected. Consideration of data gathered in the present large series of patients and in the patients followed by Sigel et al [24] lead to the conclusion that both methods are reliable, but operative sonography in experienced hands is more accurate. Both studies, using similar methods of comparison and analysis of these imaging procedures, offer a similar conclusion.…”

Section: Discussionmentioning

confidence: 69%

Comparison of operative ultrasonography and radiography in screening of the common bile duct for calculi

et al. 1987

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We report a 4-year experience of operative ultrasonography in 449 patients who underwent cholecystectomy for biliary lithiasis. Intraoperative uttrasonography and intraoperative cholangiography were performed in all of these patients and compared with the operative findings. The diagnostic accuracy of sonography was 97.5% and that of chalangiography was 94.4% in the patient group as a whole. The predictive value of a positive sonogram in this group was 96.4%, while that of a positive cholangiogram was lower at 86.9%. In 148 patients who underwent surgical exploration of the common duct, sonography appeared to have more accurately predicted presence or absence of stones (92.5 %) than did cholangiography (79.8%). Use of these intraoperative screening tests together led to a positive common duct exploration in 76.6% of the 148 patients, which is higher than our previous experience in which common duct exploration was performed on the basis of clinical criteria. In 7% of the 301 cholecystectomized patients, nnpredicted stones were detected at operative sonography and cholangiography. If the common duct exploration were to be performed based solely on the outcome of the sonogram, the rate of positive exploration could be 97%. Overall morbidity in this series was 9%, and retained stones following duct exploration were encountered in 1 patient. The overall mortality rate of the entire patient group was 0.9%. Operative ultrasonography of the biiiary tract as a screening procedure is, in experienced hands, a reliable method and substitute for operative cholangiography.

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“…Interest in this method increased in the early 1980s when several studies showed that intraoperative ultrasound was equal or superior to static IOC for detecting choledocholithiasis [15,20,21], but the technique was never widely accepted. During the OC era, the major role of intraoperative imaging was detection of CBDS, whereas during the era of LC, a greater emphasis has been placed on the role of these imaging methods in identifying anatomic variations and detecting stones.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies conducted in the early 1980s showed that intraoperative ultrasound was as accurate as intraoperative cholangiogram (IOC) for detecting choledocholithiasis during OC [15,20,21]. The advent of laparoscopic ultrasound (LUS) in the early 1990s sparked interest in this method of bile duct imaging during LC.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic ultrasound as the primary method for bile duct imaging during cholecystectomy

2007

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With moderate experience, LUS can become the primary routine imaging method for evaluating the bile duct during LC. It is as reliable as IOC for detecting choledocholithiasis. In addition, LUS can locate the common bile duct during difficult dissections. On the basis of this experience, LUS is used currently in nearly all LCs and is the sole method for bile duct imaging in 75% of these cases. IOC is used as an adjunct to LUS when LUS imaging is inadequate, when stronger clinical indicators of choledocholithiasis are present, or when biliary anatomy remains uncertain.

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Comparison of cholangiography and ultrasonography in the operative screening of the common bile duct

Cited by 16 publications

References 6 publications

Operative ultrasonography during hepatobiliary and pancreatic surgery

Operative ultrasonography during hepatobiliary and pancreatic surgery

Comparison of operative ultrasonography and radiography in screening of the common bile duct for calculi

Laparoscopic ultrasound as the primary method for bile duct imaging during cholecystectomy

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