Laparoscopic Ultrasound for Bile Duct Imaging during Cholecystectomy: Clinical Impact in 785 Consecutive Cases

The influence of laparoscopic ultrasonography (LUS) on the operative management of patients during laparoscopic cholecystectomy (LC) has not been examined in a large unselected series.

Seven hundred eight-five consecutive LC operations were reviewed to determine whether the findings of LUS for bile duct imaging altered operative management. Patients were analyzed according to the primary indication for imaging: anatomic identification (group I), possible common bile duct stones (group II), and routine use absent other indications (group III).

LUS demonstrated the cystic duct-common bile duct junction, the common hepatic duct, the common bile duct to the ampulla, and the right hepatic artery in 95.8% of cases. Among 56 of 111 (50%) patients in group I for whom initial dissection failed to result in adequate anatomic identification, subsequent LUS provided sufficient anatomic identification to allow completion of a laparoscopic operation in 87.5%. Group I patients were more likely to have acute cholecystitis (p < 0.0001) and Tokyo Guidelines 2018 grade II or III acute cholecystitis (p < 0.001). LUS changed operative management for 19 of 256 (7.5%) group II patients and 10 of 361 (2.8%) group III patients by demonstrating common bile duct stones that resulted in common bile duct exploration with stone clearance. Five patients had common bile duct stones that were not detected by LUS. There were no major bile duct or vascular injuries.

The primary value of LUS during LC is for anatomic identification when there are severe local inflammatory conditions. In this setting, LUS imaging can facilitate safe completion of LC or an early decision for an alternate operative strategy. When performed primarily for common bile duct stones or as routine practice, LUS results in CBDE for a limited proportion of patients.