The role of intraoperative ultrasonography (IOU) in the surgical treatment of hilar cholangiocarcinomawas explored in twenty-two patients, 17 males and 5 females. The mean age was55 years (range 36-78 years). Preoperative imaging studies included abdominal ultra-sonographyand/or CT scan, and visceral angiography. Operations performed were segment IIIbypass in 18 patients, local resection of tumour in 2 and resection of tumouren blocwith lefthepatectomy in 2. Interpretation of IOU in terms of vascular involvement by the tumour (ascompared to angiography or operative findings) was correct in 21 patients; no vascular invasionin 20 and portal vein invasion in the remainder. One false negative result occurred in a patientwhose IOU failed to show right hepatic artery encasement by the tumour. When compared topostoperative cholangiography or surgical specimen, IOU correctly demon-strated location andextent of the tumours in all but one patient who had incomplete tumour resection. IOU was alsohelpful in locating segment III duct for biliary bypass. The mean time used for IOU was 15.1 min(range 10-20 min.), and there was no procedure-related com-plication. When supplemented withoperative exploration, IOU seems to be very useful in the assessment of the resectability of hilarcholangiocarcinoma.
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