The diagnosis of jaundice by the minilaparotomy open transhepatic cholangiogram

The precise diagnosis of the etiology of jaundice is of considerable value to the clinician in caring for the icteric patient. A series of twenty-three patients who underwent minilaparotomy (open transhepatic cholangiogram) is presented. This procedure allows for inspection, biopsy, cholangiography and omental venography under direct visualization and at minimal risk to the patient. In this series the cause of jaundice was successfully determined in 96% of the cases. Cholangiography was used to visualize the ducts in 20 patients and in 2 others, the diagnosis was made by inspection and liver biopsy. The literature on alternative diagnostic methods is reviewed and compared to other procedures the minilaparotomy has relatively few contraindications and many advantages. It is a useful and safe technique in the face of abnormal clotting factors, obstructive jaundice, ascites or hepatitis. By using the multiple diagnostic modalities available in a minilaparotomy, the rate of successful diagnosis equals or exceeds that of the other procedures. It is therefore recommended that this approach be considered as a diagnostic tool in the evaluation of jaundice.