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Open AccessArticle

The Role of Laparoscopic Ultrasonography in the Evaluation of Suspected Choledocholithiasis. A Single-Center Experience

1
Riga East Clinical University Hospital, LV 1038 Riga, Latvia
2
Statistics Unit, Riga Stradins University, LV 1007 Riga, Latvia
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(5), 246; https://doi.org/10.3390/medicina56050246
Received: 13 April 2020 / Revised: 17 May 2020 / Accepted: 18 May 2020 / Published: 20 May 2020
(This article belongs to the Section Surgery)
Background and objectives: Opinions differ regarding the optimal diagnostic methods for patients with suspected choledocholithiasis. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) and compare it to pre-operative magnetic resonance cholangio-pancreatography (MRCP); Materials and Methods: In all patients with suspected choledocholithiasis LUS was performed during laparoscopic cholecystectomy to evaluate biliary stones. According to availability, part of the patients had pre-operative MRCP. Data for diagnostic accuracy and main outcomes were collected prospectively and analyzed retrospectively; Results: Choledocholithiasis was detected in 178 of 297 patients by LUS (59.93%) and in 39 of 87 patients by MRCP (44.8%), p = 0.041. LUS yielded a sensitivity of 99.4%, a specificity of 94.3%, a positive predictive value of 96.1% and a negative predictive value of 99.1%. However, pre-operative MRCP had a sensitivity of 61.7%, a specificity of 92.3%, a positive predictive value of 94.9% and a negative predictive value of 51.1%. Moreover, of the 47 patients with no choledocholithiasis by MRCP, in 23 cases it was later detected by LUS (a false negative MRCP finding—38.3%), p < 0.001. Median duration of hospitalization was significantly shorter in patients evaluated without pre-operative MRCP—8 days (interquartile range – IQR 11–6) vs. 11 days (IQR 14–9), p = 0.001; Conclusions: LUS may reduce the role of pre-operative MRCP and can become a rational alternative to MRCP as a primary imaging technique for the detection of choledocholithiasis. View Full-Text
Keywords: choledocholithiasis; laparoscopic ultrasonography; magnetic resonance cholangio-pancreatography choledocholithiasis; laparoscopic ultrasonography; magnetic resonance cholangio-pancreatography
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Atstupens, K.; Mukans, M.; Plaudis, H.; Pupelis, G. The Role of Laparoscopic Ultrasonography in the Evaluation of Suspected Choledocholithiasis. A Single-Center Experience. Medicina 2020, 56, 246.

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