The utility of ultrasonography for screening the common bile duct during laparoscopic cholecystectomy

Since the introduction of laparoscopic cholecystectomy, the means by which the common bile duct is evaluated, if performed at all, has been debated. When the common bile duct is to be screened, two primary modalities have emerged. These techniques are fluoroscopic cholangiography and intracorporeal ultrasonography. Fluoroscopic cholangiography during laparoscopic cholecystectomy has been shown to be effective and accurate for demonstrating ductal stones and anomalies. More recently, laparoscopic ultrasonography has been utilized for screening the common bile duct. Ultrasonography is probably more sensitive than cholangiography for demonstrating intraluminal common bile duct stones or sludge and can be performed more rapidly and at less cost than cholangiography. However, ductal anomalies may not be as readily visualized. The two techniques, therefore, appear to be complementary for evaluating the common bile duct during laparoscopic cholecystectomy, and both techniques should be taught to today's surgical trainees.