[Intraoperative cholangiography and ultrasound in laparoscopic cholecystectomy]

For years there has been a controversy as to whether or not a routine peroperative cholangiography is indicated during conventional cholecystectomy. With the introduction of the laparoscopic technique, the reasoning has changed, but the controversy persists. The surgeon of today has the choice between two diagnostic modalities, which are to be presented here. Peroperative cholangiography was the technique usually employed during conventional operation. Many surgeons are in favor of routine intraoperative cholangiography during laparoscopic cholecystectomy. The goal of the examination is no longer the detection of unsuspected common bile duct stones, but the visualization of anatomical variations of the bile ducts and hepatic arteries for prevention of bile duct injuries. A difference in number of bile duct injuries in patients examined routinely or selectively has not yet been proven, so selective use of intraoperative cholangiography is still a safe strategy. A multitude of different catheters and introducer-sets for the laparoscopic operation are commercially available. We feel that a catheter should facilitate insertion without requiring the introduction of an additional cannula. An exception are the patients with known bile duct calculi, where a laparoscopic bile duct exploration is planned and the additional cannula is needed for this procedure anyway. Intraoperative cholangiography detects bile duct stones with a sensitivity of 95 to 100%. The sensitivity for the demonstration of anatomical variations of the bile ducts is smaller and anomalies of the arteries can not be demonstrated at all.(ABSTRACT TRUNCATED AT 250 WORDS)