الفهرس 
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Abstract
Background there is huge discrepancy between the recognized causes of Obstructive Jaundice at various centers and it is mandatory to determine pre-operatively the existence, the nature of obstruction because an ill-chosen procedure can lead to high morbidity and mortality. Intraoperative ultrasound (IOUS) is being applied to great advantage in biliary surgery, both for lithiasis and tumors.
Aim To evaluate the impact of intraoperative ultrasound in changing the plan of management of obstructive jaundice compared with preoperative conventional diagnostic methods of imaging in the accuracy (visualization of biliary tree),expenses,operating time.
Methods the study was conducted on 50 patients (25 malignant cases group A, 25 calcular cases group B) with history of obstructive jaundice and (pre or intraoperative) Endoscopic retrogradeCholangiopancreatography(ERCP), each patient; will undergo intraoperative ultrasound.
Results group A malignant 40 % was the co-ordinance with pre-operative diagnosis. The IOUS co-ordinance with intraoperative diagnosis was 88 %,The P-Value is < 0.001. The result is significant at p=≤0.05. (with 91 % specificity & 86.8 % sensitivity. Average time for US procedure was 16.5 min. group B Co-ordinance with (preoperative or intraoperative) ERCP with intraoperative diagnosis was (83.3) %, while The IOUS co-ordinance with intraoperative diagnosis was 100% with 100% Sensitivity and 96.7% Specificity.
Conclusion Incorporating ultrasound into hepato-biliary-pancreatic surgery has significant rewards, not only in terms of patient benefit and outcome but also in terms of development of the surgical profession.