Journal of Ultrasound in Medicine, Vol 6, Issue 10 589-595, Copyright © 1987 by American Institute of Ultrasound in Medicine
Intraoperative imaging of the biliary tree. Sonography vs. operative cholangiography
A. R. Buckley, C. H. Scudamore, C. D. Becker and P. L. Cooperberg
Department of Radiology, University of British Columbia, Vancouver, Canada.
The accepted technique for diagnosing choledocholithiasis at the time of
cholecystectomy is operative cholangiography. Reports in the surgical
literature suggest that intraoperative ultrasound can replace operative
cholangiography in the accurate detection of common duct stones. This
prospective study was performed jointly by radiologists and surgeons
together in the operating room. Twenty-one patients underwent
intraoperative ultrasonography and operative cholangiography at the time of
cholecystectomy. In the 16 cases in which both studies were adequate, there
were 11 in which no stones were seen on either; three in which stones were
seen on both; and two in which stones were diagnosed by sonography alone.
In one of these latter cases, the stones were confirmed, making the
cholangiogram falsely negative. In the other case, no stones were found so
we presume that sonography was falsely positive. Although this technique
can be accurate and useful, it is technically demanding, even for an
experienced sonologist. We feel that this technique is likely to be of
benefit only to the surgeon with considerable ultrasound training,
expertise, and motivation.
