Comparison between Laparoscopic Ultrasound and Intraoperative Cholangiogram in Detection of Common Bile Duct Stones during Laparoscopic Cholecystectomy for Cholelithiasis: A Prospective Study

Abstract

Introduction: Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is valuable in the detection of biliary abnormalities. In this study, we aimed to investigate the diagnostic accuracy of IOC during LC for the detection of anatomic variations of the biliary system, as well as the visualization ability of IOC on determining the normal anatomy of the biliary tree. Materials and methods: This cross-sectional study was conducted on patients who were presented to the surgery outpatient clinic and were scheduled for elective LC for symptomatic cholelithiasis. Patients underwent intraoperative laparoscopic ultrasound (LUS) before the dissection of Calot’s triangle and IOC video fluoroscopy examination of the extrahepatic biliary tree. Results: Our study enrolled 53 patients. No intraoperative complications occurred in all enrolled patients. LUS was successful in all 53 (100 % ) cases, while IOC was successful in 50 (94.3 % ) cases. IOC had accuracy rate of 100 % (50 patients) in defining biliary ducts at the porta hepatis compared to 84.91 % (45 patients) for LUS with a failure rate of 15.09 % ( p = 0.60). Concerning stones detection, LUS accuracy indexes were as follows: sensitivity = 80 % ; specificity = 95.83 % ; positive predictive value (PPV) = 66.67 % ; negative predictive value (NPV) = 97.87 % 99; and diagnostic odds ratio (DOR) = 92. IOC accuracy indexes were as follows: sensitivity = 80 % ; specificity = 93.33 % ; PPV = 57.14 % ; NPV = 90 % ; and DOR = 56. Conclusion: The results of the current study encourage using IOC as an effective, accurate, feasible, and safe technique to visualize the biliary tree while performing LC.