Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones

Jamal, Karim; Smith, Henry; Ratnasingham, Kumaran; Siddiqui, Muhammed R; G, McLachlan; Belgaumkar, Ajay

doi:10.1308/rcsann.2016.0068

Cited by 44 publications

(26 citation statements)

References 48 publications

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“…Eighteen reports were identified, 13 were prospective non-randomized trials, and 5 were retrospective trials. Two meta-analyses were found, one assessing the diagnostic accuracy of LUS in detecting CBDS vs IOC[ 37 ], and a second, analyzing CBDS detection, together with costs, time taken for the examination, and ability to identify anatomical landmarks[ 38 ]. Table 1 shows the published studies, together with their respective methodologies and principal evaluated variables.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

Dili

Bertrand

2017

WJG

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AIMTo assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy.METHODSWe present a MEDLINE and PubMed literature search, having used the key-words “laparoscopic intraoperative ultrasound” and “laparoscopic cholecystectomy”. All relevant English language publications from 2000 to 2016 were identified, with data extracted for the role of LUS in the anatomical delineation of the biliary tract, detection of common bile duct stones (CBDS), prevention or early detection of biliary duct injury (BDI), and incidental findings during laparoscopic cholecystectomy. Data for the role of LUS vs IOC in complex situations (i.e., inflammatory disease/fibrosis) were specifically analyzed.RESULTSWe report data from eighteen reports, 13 prospective non-randomized trials, 5 retrospective trials, and two meta-analyses assessing diagnostic accuracy, with one analysis also assessing costs, duration of the examination, and anatomical mapping. Overall, LUS was shown to provide highly sensitive mapping of the extra-pancreatic biliary anatomy in 92%-100% of patients, with more difficulty encountered in delineation of the intra-pancreatic segment of the biliary tract (73.8%-98%). Identification of vascular and biliary variations has been documented in two studies. Although inflammatory disease hampered accuracy, LUS was still advantageous vs IOC in patients with obscured anatomy. LUS can be performed before any dissection and repeated at will to guide the surgeon especially when hilar mapping is difficult due to fibrosis and inflammation. In two studies LUS prevented conversion in 91% of patients with difficult scenarios. Considering CBDS detection, LUS sensitivity and specificity were 76%-100% and 96.2%-100%, respectively. LUS allowed the diagnosis/treatment of incidental findings of adjacent organs. No valuable data for BDI prevention or detection could be retrieved, even if no BDI was documented in the reports analyzed. Literature analysis proved LUS as a safe, quick, non-irradiating, cost-effective technique, which is comparatively well known although largely under-utilized, probably due to the perception of a difficult learning curve.CONCLUSIONWe highlight the advantages and limitations of laparoscopic ultrasound during cholecystectomy, and underline its value in difficult scenarios when the anatomy is obscured.

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Section: Resultsmentioning

confidence: 99%

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

Dili

Bertrand

2017

WJG

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“…We agree with other authors that as a noninvasive, safe, less costly and faster method, LUS should be the primary imaging method during LC, whereas IOC should be used only when any doubts exist. 7,17 Our success rate with LUS was 100% (a safe plane of dissection, no biliary or vascular complications), while the success rate for other authors varied between 95-100% with LUS and 89-97% with IOC (albeit other authors' definition of "success" was not clear). 18 The conversion rate from LC to open cholecystectomy varies from 2.6% to 11.9%.…”

Section: Discussionmentioning

confidence: 77%

Using laparoscopic ultrasound to delineate dangerous anatomy during difficult laparoscopic cholecystectomies

Sebastian¹,

Sroczyński²,

Rudnicki³

2019

Adv Clin Exp Med

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Background. Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is not as common now as in the past, but it is still a very debilitating complication. Therefore, there is a very strong need for a method that lowers the number of complications during LC without any additional risks for the patient and the operating team. Laparoscopic ultrasound (LUS), which serves to delineate anatomy, appears to be a very effective and safe technique. Objectives. The aim of this study was to explore the advantages of performing LUS during difficult LC. Material and methods. The study group consisted of 126 patients who underwent surgery between January 2014 and February 2016. All the patients had difficult intraoperative anatomical conditions due to chronic inflammation, previous upper abdominal surgery or biliary pancreatitis in the past. We used a Toshiba PEF-704 LA laparoscopic probe and the Toshiba NemioMX SSA-590A diagnostic ultrasound system (Toshiba Corp., Tokyo, Japan). Doppler sonography was used to differentiate between vascular and biliary structures. Results. Laparoscopic ultrasound ensured a safe plane of dissection and no biliary or vascular complications were observed. Stent insertion into the common bile duct before the operation undoubtedly made the identification of anatomical structures easier. Conversion to an open procedure was deemed necessary in only 6 patients (4.8%). Conclusions. Laparoscopic ultrasound facilitates the successful performance of LCs. It can be used at any time during the operation; it is noninvasive; and there is no need to use X-rays or contrast dye, or to cannulate the cystic duct. The most important advantage of LUS is that it leads to a lower number of conversions and intraoperative complications by identifying anatomical relationships in the plane of dissection.

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“…The main advantages of LUS are that it does not involve ionizing radiation, is quicker to perform, has a lower failure rate and can be repeated during the procedure as required. 2 All the evidence shows excellent results with LUS in delineating the biliary anatomy. The advantages of LUS over IOC are the shorter procedure time, its noninvasive nature, and lack of use of radiation.…”

Section: Discussionmentioning

confidence: 86%

“…IOC is currently regarded as the gold standard in the detection of choledocholithiasis during LC. 2,7 However, routine IOC during LC is often not performed because of increased operative time, radiation, and failure rate. 8 LUS is an attractive alternative with several potential advantages.…”

Section: Discussionmentioning

confidence: 99%

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The feasibility and accuracy of laparoscopic ultrasonography during laparoscopic cholecystectomy

Abou-Shady

2016

Int Surg J

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Background: During laparoscopic cholecystectomy (LC), intraoperative cholangiography (IOC) is currently regarded as the gold standard in the detection of choledocholithiasis. When laparoscopic ultrasonography (LUS) emerged as a viable diagnostic adjunct, it was hypothesized that its routine use would facilitate dissection, detect occult choledocholithiasis, and prevent bile duct injury (BDI) during LC. The aim of this study was to evaluate the feasibility of LUS during LC, and to evaluate its routine use in reducing bile duct complications during LC. Methods: Forty consecutive patients with gall stones disease scheduled for LC were included in this study. Initial abdominal ultrasound scan was done for all patients. LUS of the liver and the biliary system was done during LC. The success rate of the procedure, operative time, accuracy in the diagnosis of bile duct stones, and delineation of exact biliary anatomy were evaluated. Results: Forty patients (30 females and 10 males) with a mean age of 43.5 years (range, 26 to 58). The mean time required to complete the LUS examination was 11.40 minutes (range, 5 to 20). Adequate LUS visualization of the common bile duct (CBD) occurred in 40 patients (100%) and of the common hepatic duct (CHD) in 38 patients (95%). It identified 37 patients with gall bladder stones. Thus in terms of the detection and exclusion of gall bladder and common bile duct stones, the sensitivity and specificity of LUS were 94.8 percent and 100 percent respectively. LUS excluded the presence of stones in 3 cases reported to have gall stones by abdominal ultrasound (sensitivity and specificity of abdomen ultrasound were 86.5% and 100% respectively). Bile leak occurred in one patient and was treated nonoperatively. No other major bile duct injury occurred during LC. Conclusions: LUS gives better identification of vascular structures and anatomic relationship of bile duct to the portal vein and hepatic arteries. The routine use of LUS is safe and accurate and avoids biliary complications during LC.

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Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones

Cited by 44 publications

References 48 publications

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy

Using laparoscopic ultrasound to delineate dangerous anatomy during difficult laparoscopic cholecystectomies

The feasibility and accuracy of laparoscopic ultrasonography during laparoscopic cholecystectomy

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