Comparaison de l'echolaparoscopie et de la cholangiographie\ud lors des cholecystectomies laparoscopiques

Abstract

Aim - Prospective evaluation of the results of laparoscopic ultrasound and cholangiography to investigate choledocholithiasis and detect variations in biliary anatomy during laparoscopic cholecystectomies.\ud \ud Methods - The biliary trees of 600 patients who underwent laparoscopic cholecystectomy were routinely explored by laparoscopic ultrasound and cholangiography.\ud \ud Results - Laparoscopic ultrasound was performed in all 600 cases. Cholangiography was perFormed in 498 (83%). Laparoscopic ultrasound required less time than cholangiography: 10.2 minutes versus 17. 9 minutes (p=0.0001). Common bile duct stones were detected intraoperatively in 40 cases (7%). Both methods were equally effective. The sensitivity of laparoscopic ultrasound was 80% and its specificity 99%. For cholangiography these values were 75% and 98%; respectively. For laparoscopic ultrasound, false positives\ud and False negatives were noted in the First 45 cases of individual trainees. Nevertheless, cholangiography showed 30 anatomical anomalies and laparoscopic ultrasound only 15.\ud Conclusion - Laparoscopic ultrasound can be performed rapidly and in all cases. Results are comparable to cholangiography in the detection of common duct stones. Individual training is necessary to optimize efficacy. Anatomical anomalies are often missed