Abstract
Objective: More than 60,000 laparoscopic cholecystectomies are performed annually in the United Kingdom. Classically, on-table cholangiogram (OTC) has been used to visualise the biliary tree and assess common bile duct (CBD) stones. Increasingly, hospitals are adopting intraoperative ultrasound (IOUS) to assess the CBD for stones. This service evaluation aimed to compare the use of IOUS and OTC in the detection of gallstones in the CBD during cholecystectomy in a high-volume centre. Methods: An observational cohort evaluation was performed at Portsmouth Hospitals University NHS Trust, United Kingdom, including all consecutive patients who underwent a cholecystectomy with intraoperative imaging of the CBD in 2023. Patients were assigned to the OTC or IOUS groups on the basis of the type of imaging technique used. Baseline characteristics and procedural data were collected. Whether retained stones were identified during follow-up, with at least 12 months of follow-up. Results: A total of 1016 patients underwent a cholecystectomy at our centre. And 511 of these patients (50.3%) had intraoperative bile duct imaging with either OTC (n = 333) or IOUS (n = 178). Overall, the duration of surgery was longer in the OTC group than in the IOUS group (87.3 ± 43.0 min vs. 74.7 ± 33.0 min, p < 0.001). The complication rates were similar in both groups (3.9% vs. 7.3%, p = 0.146). Following OTC, 255 (76.6%) patients were deemed to have a clear CBD, and 6 patients presented with retained stones. Another 3 patients presented with retained stones after undergoing CBD exploration in the same procedure, where the CBD was deemed clear at the end of the procedure. OTC demonstrated an estimated sensitivity of 96.2% and a specificity of 97.6%. Following the IOUS, 149 (83.7%) patients were deemed to have a clear CBD, and 5 patients presented with retained stones. IOUS demonstrated an estimated sensitivity of 100% and a specificity of 96.6%. Conclusion: No differences were detected between OTC and IOUS with regards to complications, sensitivity, or specificity in the assessment of the CBD. IOUS was generally faster to apply and requires fewer resources. In cases of unclear biliary anatomy or equivocal intraoperative findings, the IOUS and OTC may be used as complementary imaging modalities to aid in intraoperative decision-making.