Operative cholangiography: evaluation and a plea for its general use.

Operative cholangiography should be used routinely during operations on the gallbladder and biliary tree. The indications for operative cholangiography include demonstration of unsuspected stones, of abnormal biliary tree anatomy, and of tumour within intrahepatic branches of the biliary tree; determination of the nature of periampullary obstruction and of the best approach for removal of stones impacted low in the common bile duct; avoidance of unnecessary choledochotomy; assistance in diagnosis of stenosing cholangitis, cholangiolytic jaundice or choledochal cyst; and to ensure, postexploration, that the duct contains no stones. These indications were evaluated in a review of the records of 151 patients who underwent biliary tract operations. Operative cholangiography was performed in 133 of these patients. The review disclosed that 5.7% of common bile duct stones were totally unsuspected and that 30% of common bile ducts suspected to be abnormal were proven to be clear of stones, so that an unnecessary choledochotomy was avoided. The technique of operative cholangiography is simple, but successful use of it requires meticulous attention to detail and frequent use by a regular team.