Routine operative needle cholangiography in cholecystectomy for gallstones. A prospective study of 486 patients

Operative needle cholangiography (CG) and its routine use in cholecystectomy for gallstones were prospectively studied in a series of 486 patients. The failure rate of needle CG was 0.6%, and in 6.6% of the series adequate CG films were obtained first after repeated examination. There were no postoperative complications attributable to the CG technique. The sensitivity of the method to reveal common duct stones was 100% as judged from 5 to 7 years of follow-up, while the sensitivity of the classic signs suggesting common duct obstruction was 89% when calculated on combined signs. The respective specificities in regard to choledocholithiasis were 91 and 67%. Among 203 patients with clinically suspected common duct stones, CG yielded normal findings in 110 and was false positive in 11 (54 and 5.4%). Among the 283 patients without clinical suspicion of common duct stones, 9 proved to have such stones and in 14 the CG was false-positive (3.2 and 4.9%). The greater than 3% incidence of choledocholithiasis which was clinically unsuspected (11% of all cases of common duct stone), and the circumstance that choledochotomy could be avoided in about half of the patients with clinically suspected stone, advocate routine performance of CG. We believe the needle technique to be the CG procedure of choice in most cases. The possibility of reducing the incidence of false-positive findings is discussed.