Quality and interpretation of operative cholangiography in a district general hospital

The quality and interpretation of operative cholangiography were assessed in 128 patients undergoing cholecystectomy. The quality of each cholangiogram was assessed by calculating a cholangiogram score according to the anatomical structure visualized. Out of a maximum possible score of 5, 26% of cholangiograms achieved a score of less than or equal to 3 and were considered as technical failures. The sensitivity, specificity and negative predictive values regarding the surgeon's interpretation of the cholangiograms were high and compared well with the radiologist's assessment. However, the positive predictive value for the surgeon's assessment of the cholangiograms was 74% compared with 95% for the radiologist (P less than 0.02). Improvement in cholangiography can only be achieved by greater attention to detail and perseverance. After an adequate examination, the only criteria for common bile duct exploration should be the presence of filling defect(s).