Objective: Laparoscopic ultrasound (LUS) has been used to diagnose bile duct (BD) stones and delineate anatomy during laparoscopic cholecystectomy (LC) for over 10 years. LUS as a modality to prevent BD injury has not been reported in a large series. This study proposes to determine the effect of LUS on preventing BD injury.
Methods: A multi (five)-institutional, retrospective study was performed by reviewing charts, operative notes and LUS imaging by surgeons experienced with LUS.
Results: 1312 patients had LC in which LUS was routine. The ratio of acute to chronic cholecystitis was 1:4. In 28 (2%) patients, LUS was unsuccessful to do a complete evaluation due to technical difficulties and intraoperative cholangiogram was used; its use also varied depending on institutes (average 37%), mostly for resident training. LUS was considered remarkably valuable to safely complete LC, avoiding conversion to open, in 59 patients (6%). For screening of BD stones (positive in 141 patients, 11%), LUS had a false positive rate of 0.1% and a false negative rate of 0.3%. There were 3 (0.2%) retained stones. 3 (0.2%) minor bile leaks secondary to Type A liver bed injury occurred; however, there were no other BD injuries or LUS adverse effects.
Conclusions: The routine use of LUS during LC has obviated major BD injuries compared to the reported rate (1 out of 200-400 LCs). LUS improves the safety of LC by clarifying anatomy and reducing bile duct injuries.
Program Number: P327