Evaluation of laparoscopic ultrasound as a routine method for assessment of common bile duct patency in patient with history of calcular obstructive jaundice

Intraoperative cholangiogram (IOC) is routinely used during cholecystectomy (either open or laparoscopic) in cases of cholelithiasis with history of obstructive jaundice (OJ). It is performed in such cases with no preoperative imaging that confirms the patency of biliary tree and during exploration of common bile duct. Intraoperative ultrasound (IOUS) has recently become a visualizing tool for anatomy and pathology of biliary tree which is safe, faster and less invasive compared to IOC. This is a prospective controlled randomized trial, conducted on 60 patients undergoing laparoscopic cholecystectomy for cholelithiasis with history of OJ, with no present OJ. It was held in the surgery department in Faculty of Medicine, Menoufia University and Theodor Bilharz Research Institute, from 2014 to 2017. Each patient underwent IOUS then, IOC during laparoscopic cholecystectomy. The study compared between both imaging techniques regarding procedure time, visualization of biliary tree, detection of any common bile duct (CBD) stone, biliary or vascular anomalies, and intra-or postoperative complications in the form of obstructive jaundice or iatrogenic biliary injury. The results showed a significant difference in time of the procedure with a mean time (min) of 9.60±1.224 (3-25) in IOUS and 14.391±1.356 (5-30) in IOC. Mean CBD diameter (mm) is 5.280±0.6957 (2.8-18) in IOUS & 7.010±0.7162 (3.5-22) in IOC without significant differences. IOUS has 100% sensitivity and 96.7% specificity while IOC has 100% sensitivity and 100% specificity. A case with vascular anomaly and one with duct anomaly were detected by IOUS. The vascular anomaly could not be detected with IOC. There was no post-operative complication in the form of missed CBD stones or bile leakage