Operative cholangiography in the surgery of gallstones: implementation of a policy decision in a consecutive series of 327 patients.

Operative cholangiography was introduced with the major objectives of demonstrating previously unsuspected bile duct calculi, avoiding fruitless choledocholithotomy, and reducing the incidence of residual duct calculi. This report describes the effects on patient management of a policy of routine operative cholangiography in the surgery of gallstones in the Professorial Surgical Unit at the Royal Brisbane Hospital. All three objectives were realized, but for full achievement of the potential of the technique, skill, experience, and persistence are required by the surgeon, both to obtain satisfactory pxeexploratory and completion cholangiograms, and to remove all demonstrated calculi at the primary procedure. Summary A review has been carried out of the effect on patient management of the use of routine operative cholangiography in a series of 327 patients undergoing surgery for gallstones in the Professorial Surgical Unit at the Royal Brisbane Hospital. Operative cholangiography was carried out in 82% of cases, and the technique failed in 16% of these. The reasons for failure are analysed. Operative cholangiography is a reliable and accurate method of predicting the presence of choledocholithiasis. It can dispense with the necessity for choledochotomy in a significant number of cases where clinical indications for duct exploration exist, and occasionally reveals a previously unsuspected stone. With cholangiography, the incidence of retained stone after cholecystectomy should approximate to zero. Completion cholangiography reduces the incidence of retained ductal stone after choledocholithotomy, but in order to reduce the incidence still further, skill, experience and persistence are required by the surgeon in obtaining an adequate cholangiogram, in the interpretation of the cholangiogram, and finally in the removal of the duct stones. It is recommended that operative cholangiography should be performed as a routine during biliary surgery.