Evaluation of peroperative cholangiography during cholecystectomy

In a retrospective investigation comprising 219 choledochotomies, of which 57 were explorative (26%), and 162 were choledocholithotomies (74%), an attempt has been made to evaluate the indications for exploration of the common duct and the diagnostic reliability of post-explorative cholangiography. Retrospectively, we find that explorative choledochotomy was justified in 40 out of 57 cases, unless the risk of overlooking stones in the bile ducts was to be increased. In the remainder of the cases (17/57) it was a question of either misinterpretation or of non-evaluable cholangiograms. A diagnostic reliability of 93.6% was obtained at post-explorative cholangiography, making incidence of residual stones at postoperative cholangiography 6.4%. The errors were due to either technically poor cholangiograms (4/14) or misinterpretations (10/14). The conclusion is that peroperative cholangiography is a most important aid in diagnosing stones in the bile ducts before as well after choledochotomy, but that the results presumably to some extent can be improved by using radiological expertise.