Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy: A meta-analysis of diagnostic accuracy

• Laparoscopic ultrasound is a less invasive alternative to intra-operative cholangiography.
• There remains a need assess the diagnostic accuracy of these two investigations in detecting common bile duct stones.
• This study identifies laparoscopic ultrasound as an equivalentalternative to intraoperative cholangiography.

BackgroundRoutine intra-operative cholangiography (IOC) during laparoscopic cholecystectomy is often not performed because of increased operative time, radiation, and failure rate. Laparoscopic ultrasound (LUS) is a less invasive alternative but studies comparing it to IOC have been of small sample size. This study aims to assess the diagnostic accuracy of LUS in detecting common bile duct (CBD) stones compared to IOC.MethodsThis meta-analysis was executed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement. 11 comparative studies (1994–2013) reporting on 12 patient groups were included. A bivariate model for diagnostic meta-analysis was used to attain overall pooled sensitivity and specificity for IOC and LUS, and their relationship assessed using a hierarchical summary receiver operating characteristic model with meta-regression.ResultsIOC had a pooled sensitivity of 0.87 (95% CI 0.77–0.93) and a pooled specificity of 0.99 (95% CI 0.98–0.99) with no significant heterogeneity. The diagnostic Odds Ratio (OR) was 442 (95% CI 196–997) and pooled weighted Area Under the Curve (AUC) was 0.99 (95% CI: 0.98–1.0). LUS had a pooled sensitivity of 0.87 (95% CI 0.80–0.92) and a specificity of 1.00 (95% CI 0.99–1.00). Heterogeneity was significant for specificity results. The diagnostic Odds Ratio (OR) was 1171 (95% CI 372–3689) and the pooled, weighted AUC was 1 (95% CI: 0.99–1). Meta-regression did not identify factors that significantly predict diagnostic accuracy.ConclusionsLUS is a potentially useful imaging modality to confirm the absence of CBD stones without needing to cannulate the biliary system.