[Comparison of laparoscopic ultrasound and cholangiography during laparoscopic cholecystectomies. Results of a prospective study]

AIM

Prospective evaluation of the results of laparoscopic ultrasound and cholangiography to investigate choledocholithiasis and detect variations in biliary anatomy during laparoscopic cholecystectomies.

METHODS

The biliary trees of 600 patients who underwent laparoscopic cholecystectomy were routinely explored by laparoscopic ultrasound and cholangiography.

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 and false negatives were noted in the first 45 cases of individual trainees. Nevertheless, cholangiography showed 30 anatomical anomalies and laparoscopic ultrasound only 15.

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.

[Laparoscopic treatment of pancreatic pseudocyst. 3 cases]

Three patients with pancreatic pseudocysts were treated laparoscopically by cysto-enteric by pass. Two developed a large cyst in the course of acute biliary pancreatitis. The third patient had chronic pancreatitis of unknown etiology. The mean size of the collection was 12 cm (8-20). Treatment was performed with a delay of 80 days (30-300) after the onset of the disease. Two patients underwent laparoscopic cysto-gastrostomy using laparoscopic ultrasound. Stapling anastomosis appears easy and safe. The third patient underwent operating laparoscopically assisted cysto-jejunostomy with an-Y loop. Mean time was 120 minutes (90-200) and hospital stay was 7 days (5-8) without morbidity. The follow-up was 18 months without radiological recurrence and with excellent clinical results.

Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations

The incidence of serious trocar accidents was evaluated from a retrospective French study of 103,852 laparoscopic operations involving almost 390,000 trocars. Seven perioperative deaths occurred (mortality 0.07/1,000), arising almost exclusively from vascular injuries. The incidence of vascular injuries was 0.4/1,000. There were injuries to almost all the abdominal organs and most of the abdominal vascular tree. In the absence of any well-defined safety regulations, the technique of open insertion of the first trocar would appear to be the best means of preventing these accidents.

[Laparoscopic surgery: injuries caused by trocars. (French Survey 1994) in reference to 103,852 interventions]

In a French retrospective survey including 103,852 laparoscopic procedure, and 390,000 port-insertion, trocar injuries rate have been evaluated. Mortality is 0.07 per thousand, quite exclusively in relation with vascular injuries (especially from aorta and iliac vessels) with a rate of 0.4 per thousand. All intra-abdominal viscera and vessels must be injured by the first blind trocar insertion. Open laparoscopy is systematically proposed to prevent these accidents.