Cholangiography during cholecystectomy: a plea for selective use

Routine peroperative cholangiography was retrospectively studied in 376 patients who underwent elective cholecystectomy. Adequate cholangiograms were obtained in 325 patients using a C-arm image intensifier. Pre- and peroperative indications for common bile duct stones were correlated to the outcome of peroperative cholangiography. The sensitivity and specificity of the cholangiographic technique were 96 and 95 per cent respectively. A false-positive rate of 4.6% and a false-negative rate of 0.6% were found. No serious complications due to the method were observed. Peroperative cholangiography prevented unnecessary exploration of the common bile duct in 70 per cent of the patients with clinical indications for exploration. Abnormal cholangiograms were rare (0.8%) in the absence of clinical signs of stones in the bile ducts. These results demonstrate that selective rather than routine peroperative cholangiography should be performed.