[The importance of intraoperative diagnosis in biliary lithiasis]

Intraoperative cholangiography continues to be the principal investigation in the intraoperative diagnosis of biliary disease. Cholangiography and preoperative echography, the clinical aspect are not sufficient to exclude the possibility of choledochal lithiasis in operations carried out for straightforward cholelithiasis. Personal experience in a series of 248 bile lithiasis operations is examined: intraoperative diagnosis was based on 244 cholangiographies, 41 echographies and 22 choledochoscopies. Choledochoscopy proved decisive for evidencing residual choledochal calculi after seemingly accurate choledocholithotomy operations and also after trans-Kehr intraoperative cholangiography. Intraoperative echography, in the light of rather limited experience, would seem to add nothing to the two previous associated intraoperative instrumental investigations; it may prove useful in certain special cases.