Related Experiment Video
Updated: May 11, 2026
Application of Laparoscopic Ultrasonography in Primary Choledochal Suture during Combined Two-lens Surgery
Published on: March 28, 2025
Selective utilization of pre-operative endoscopic ultrasound to exclude choledocholithiasis prior to laparoscopic
Tali Shapiro1, Ehud Melzer, Yuval Binder
1Department of General Surgery, Kaplan Medical Center, (affiliated to the School of Medicine, Hebrew University and Hadassah, Jerusalem), Rehovot, Israel.
Background/Aims:
The objective of this study was to define the clinical, biochemical and ultrasonographic criteria correlating with a likelihood of a positive preoperative endoscopic ultrasound (EUS) in patients presenting with acute gallstone-related pancreatobiliary disease.
Methodology:
All patients who underwent EUS prior to elective laparoscopic cholecystectomy were analyzed at the Gastroenterology Unit, Kaplan Medical Center, following acute admission with cholecystitis, cholelithiasis, cholangitis, acute pancreatitis and obstructive jaundice.
Results:
One hundred and seventy four patients met the inclusion criteria. EUS showed choledocholithiasis in 37 (21.3%) with 35/37 undergoing a preoperative ERCP (24/35 cases - 64.9% positive yield). Twenty seven of the positive EUS studies (73%) were performed during the acute illness, with 50 of the 137 negative studies (36.4%) performed during the acute phase of the illness (p=0.0001). On multivariate analysis, a positive EUS was more commonly found during the acute phase of the illness [OR: 3.445; 95% CI: 1.48-8.008, p=0.004] or if there was transient jaundice [OR: 1.167; 95% CI: 1.002-1.36, p=0.047].
Conclusions:
The timing of the examination influences the detection rate of CBD stones by EUS prior to surgery although it may be appropriate to more selectively use EUS in those patients with hyperbilirubinaemia and/or where the CBD is dilated.
