Post-exploratory operative cholangiography: is it a useful technique to check clearance of the common bile duct?

The films of 37 consecutive post-exploratory operative cholangiograms were reviewed. Approximately half of the cases showed obstruction to contrast flow into the duodenum, but there was no relationship between obstruction and retained calculi. The obstruction probably occurs proximal to the ampulla at the choledochal sphincter. In only one case was a stone found that would otherwise have been missed by the omission of a post-exploratory film from the operative cholangiogram. In the six cases in which stones were missed, the post-exploratory operative cholangiogram was misleading. It is suggested that the post-exploratory operative cholangiogram is not a reliable way of checking common bile duct clearance prior to closure of the abdominal wound.