[Intravenous cholangiography is not indicated before cholecystectomy for uncomplicated lithiasis]

The purpose of this prospective study was to assess the usefulness of intravenous cholangiograms before elective cholecystectomy for lithiasis. The accuracy of preoperative intravenous cholangiography to detect choledocolithiasis was compared with that of routine operative cholangiography. All patients had preoperative intravenous cholangiography provided that they did not have known common bile duct gallstones or a previous history of adverse reaction to iodine. As well, patients presenting with cholestasis, cholecystitis or cholangitis were excluded. A choledocotomy was performed when the operative cholangiography disclosed choledocolithiasis; the preoperative intravenous cholangiograms were shown to the surgeon only after the operation. One hundred patients were selected among 206 consecutive operations for biliary lithiasis. A choledocolithiasis was detected in 3 preoperative and in 9 operative cholangiographies. Twelve choledocotomies were performed: one or more stones (1 to 12) were found in 9 patients; operative cholangiography was accurate in all these cases whereas preoperative cholangiography was accurate in only 2 (sensitivity = 22 percent). We conclude that preoperative cholangiography is useless before elective cholecystectomy for lithiasis and is unreliable to select patients in which operative cholangiography could be omitted.