Routine operative cholangiography

Abstract

The usual clinical and operative indications for exploration of the common bile-duct in cholecyst-ectomies or the selective use of operative cholangio-graphy in such cases are discussed and compared with 150 unselected cases of cholecystectomy and routine operative cholangiography. As far as calculi in the common duct are concerned, it seems fair to say that routine operative cholangiography demonstrates stones that would otherwise be left in situ and reduces the cases in which exploration of the common duct is needed. In this series, stones were present in the common bile-duct in 16 per cent; in about one-fifth of these their presence was unsuspected clinically and at laparotomy. Routine use of the technique is found to reduce the number of false positives. An important secondary benefit of cholangiography is its demonstration of duct anatomy. Various points of technique are discussed, in particular the use of the cystic duct catheter for post-exploration radiography, drainage, and postoperative radiography. Routine operative cholangiography appears to be a useful adjunct to cholecystectomy.