Peroperative cholangiography: routine or selective?
The detection and removal of common bile duct stones remains a major challenge for the general surgeon. Peroperative cholangiography offers the most reliable method of detection and its routine use is now well accepted. This study of 262 cholecystectomies reassesses the value of this procedure and investigates the recent claim that cholangiography should be performed selectively rather than routinely. With routine cholangiography a positive exploration rate of 66% was achieved and retained stones occurred in 5% of patients with choledocholithiasis. Suggestions are made for ways in which the positive exploration rate could have been greatly improved. Had selective cholangiography been employed 47% of patients would have had the examination, the positive exploration rate would have been 70%, but the retained stone rate might have been 10%. In the light of this there appears little to commend selective cholangiography and we should continue to advise its routine use.
D002758:Cholangiography; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery*; D003955:Diagnostic Tests, Routine; D005544:Forecasting; D006801:Humans; D007430:Intraoperative Care