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Andrea Pietrabissa, MD; Giulio Di Candio, MD; Pier Cristoforo Giulianotti, MD; Sami M. Shimi, MD, ChB, FRCS; Alfred Cuschieri, MD, ChM, FRCS; Franco Mosca, MD

Arch Surg. 1995;130(10):1110-1114.

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.

(Arch Surg. 1995;130:1110-1114)

Author Affiliations
From the Istituto di Chirurgia Generale e Sperimentale, Università di Pisa, Pisa, Italy (Drs Pietrabissa, Di Candio, Giulianotti, and Mosca); and the Department of Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland (Drs Shimi and Cuschieri).

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