Operative cholangiography and overlooked stones

In a series of 100 consecutive common bile duct explorations in which stones were present and operative cholangiography performed, 22 patients were found to have residual stones. The operative cholangiograms showed the missed stones in three fourths of the patients, even though many of the cholangiograms were of poor quality. It is concluded that operative cholangiography is an excellent technique that will demonstrate most common bile duct stones. Closer cooperation with the radiologist and more emphasis on technique should lead to consistently satisfactory films and more appropriate interpretation, thus resulting in fewer overlooked biliary calculi.