Operative cholangiomanometry as a guide to common duct exploration.
A trial of operative cholangiomanometry was proposed as a guide to common duct exploration to see if this technique would help in reducing the incidence of unnecessary common bile duct explorations and the incidence of retained stones. The technique for operative cholangiomanometry as modified from White is described. This method was used in 21 patients. A very close correlation between manometry and cholangiography in predicting the presence of pathology within the common duct at the time of extrahepatic biliary surgery was shown. Flow was the most accurate diagnostic parameter. Seven patients who were found to have common duct stones had both abnormal manometry and cholangiography. Fourteen patients without stones included 12 with negative cholangiography and manometry, and two in which manometry was normal but cholangiography suggested pathology. Common duct manometry and cholangiography can be used to decrease the number of unnecessary common duct explorations and the incidence of retained stones. The theory that common duct pathology will increase pressure and decrease flow rates is supported by this study. Manometry and cholangiography should be used in combination as they are additive studies. Criteria for deciding when to explore the common duct are presented.
D000328:Adult; D000368:Aged; D002758:Cholangiography / Q000379:methods*; D003135:Common Bile Duct; D003137:Common Bile Duct Diseases / Q000175:diagnosis; D005260:Female; D042882:Gallstones / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged