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Intraoperative ultrasonography (IOUS) during laparoscopic cholecystectomy

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Abstract

Background: The purpose of this study was to evaluate the usefulness of intraoperative ultrasonography (IOUS), a new method of imaging the biliary tree and related structures, during laparoscopic cholecystectomy.

Method: An IOUS probe (Aloka, Tokyo, Japan) with a 7.5-MHz linear-array transducer was used during cholecystectomy in 124 patients with symptomatic cholelithiasis (45 men, 79 women; mean age, 48±14 years).

Results: The examination of the common bile duct (CBD) was excellent in 117 patients but unsatisfactory in 7 cases (5.6%) at the level of the head of the pancreas. In 5 patients, IOUS showed unsuspected choledocholithiasis: a subsequent intraoperational cholangiogram confirmed this. In five cases IOUS was able to help the surgeon to localize a Calot area obscured by inflammation. Postoperatively, one patient had an injury of the cystic duct stump: a nasobiliary tube resolved the bile leakage after 7 days. Another patient was submitted to postoperative endoscopic retrograde cholangiopancreatography (ERCP) for a choledocholithiasis recognized by a trans-cystic-tube cholangiography: the stone was suspected but not demonstrated either by laparoscopic IOUS or by intraoperative cholangiography. During the follow-up period, one patient had an episode of acute pancreatitis. ERCP showed a small stone wedged in the sphincter of Oddi.

Conclusions: IOUS may be a real alternative to cholangiography during laparoscopic cholecystectomy since it is safer and offers a complete examination of the biliary tree. It has some disadvantages which can solved by additional experience.

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Authors and Affiliations

  1. Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, Via A. di Rudinì 8, 20142, Milano, Italy

    R. Santambrogio, P. Bianchi, E. Opocher, A. Mantovani, L. Schubert & F. Ghelma

  2. Chirurgia 1, Istituto di Scienze Biomediche Ospedale San Paolo, Via A. di Rudinì 8, 20142, Milano, Italy

    M. Panzera & M. Verga

  3. Chirurgia 2, Ospedale Fatebenefratelli e Oftalmico, 20121 AC So di Porta Nuova 23, Milano, Italy

    G. P. Spina

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  1. R. Santambrogio
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  2. P. Bianchi
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  3. E. Opocher
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  4. A. Mantovani
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  5. L. Schubert
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  6. F. Ghelma
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Santambrogio, R., Bianchi, P., Opocher, E. et al. Intraoperative ultrasonography (IOUS) during laparoscopic cholecystectomy. Surg Endosc 10, 622–627 (1996). https://doi.org/10.1007/BF00188514

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  • DOI: https://doi.org/10.1007/BF00188514

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