Ultrasonic imaging during biliary and pancreatic surgery.

Real-time ultrasound scanning was used during operations on the biliary tract and pancreas. The principal application in biliary surgery was to evaluate the common bile duct for presence of calculi. Our initial experience indicates that operative ultrasonography compares favorably with operative cholangiography. In pancreatic operations, ultrasound has been helpful in the management of pseudocysts and chronic pancreatitis. For pseudocysts, ultrasonography has indicated cyst wall thickness and the presence of adjacent anatomic structures. Ultrasound has distinguished the fluid loculations of the pseudocyst from swelling due to inflammatory edema. In surgery for chronic pancreatitis, ultrasonography has revealed the size and location of pancreatic ducts. This information has been useful in helping select sites for internal drainage of pseudocysts and in chronic pancreatitis with ductal dilatation. Operative ultrasonography is a relatively simple procedure which has the potential for providing the surgeon with early information and decreasing the need for dissection and radiographic imaging.