[The role of sonography in laparoscopic cholecystectomy]

Between January 1991. and December 1993. in the 3rd Surgical Department of Semmelweis Medical University 735 laparoscopic cholecystectomies were performed. Intraoperative and postoperative complications occurred in 2.7% and 3% respectively. Conversion to open procedure was necessary in 8.4%, reintervention was indicated in 2.3%. The total occurrence of common bile duct stones was noticed in 1.6%. The incidence of bile duct injury 0.54%. The role of sonography in laparoscopic cholecystectomy is multiple: patient-selection, diagnosis of complications, ultrasound guided interventions in cases of complications, follow up of patients. The authors compared in 419 cases the preoperative sonography with the intraoperative finding. The risk of intra- and postoperative complications was significantly higher if the stone was impacted into the cystic region, if the gallbladder was enlarged, especially with wall-thickening and signs of acute inflammation. The fibrosis and scarring of gallbladder represent an increased risk as well. The accuracy in estimation of common bile duct dilatation is very high, but in the judgement of bile duct stones there was a high false positive rate. In spite of this, the echography is very well applicable for patient-selection. In the patient group selected with positive sonographical finding for open cholecystectomy, the prevalence of common bile duct stones was 25%, compared with 1.6% in laparoscopic group. In cases of postoperative complications the diagnostic sonography may be followed with ultrasound-guided puncture and/or drainage.