303 Does Intraoperative Ultrasound Have Additional Value in the Treatment of Gallstone Disease?

Abstract Background Intraoperative ultrasound (IOUS) is a non-invasive intraoperative imaging that can identify bile duct stones (BDS) and facilitate single-stage treatment. This study aims to evaluate the additional value of IOUS in patients with pre-operatively suspected/confirmed and failed treatment of BDS. Method Retrospective study of patients who underwent IOUS during cholecystectomy (LC) between 2020 and 2023. IOUS is used selectively in patients with suspected BDS and routinely in every patient before the laparoscopic bile duct exploration (LCBDE). Results 323 patients underwent LC +/- LCBDE (median age: 58 yrs., range 18-88, females: 69.6%). 122 (37.8%) patients had IOUS; 59 had IOUS +LC (48.3%) and 63 had LC +IOUS+LCBDE. Pre-operative imaging confirmed BDS in 79 (24.4%) patients. 35 patients (44%) underwent pre-operative ERCP with a success rate of 74.3%. In nine patients who had failed ERCP, three (33%) had BDS on IOUS. In 44 patients with pre-op BDS and had no ERCP, IOUS did not show BDS in 8 (18%). Overall, 11 patients (14%) who had BDS on pre-operative imaging did not have BDS on IOUS. Fifty-seven (23.2%, 57/245) patients had IOUS, which showed BDS in 11 (19.2%) patients. IOUS has changed the management in 22 patients (18%). IOUS False positivity was 5.5% (3 out of 54 patients) compared to 13% with MRCP. Conclusions Intraoperative ultrasound has changed the management of patients with suspected/confirmed BDS in 20% of patients. In over 50% of patients, IOUS facilitated single-stage treatment. We recommend its use to facilitate single-stage treatment of BDS.