The value of routine peroperative cholangiography--a report of 4000 cholecystectomies

A total of 4000 consecutive cholecystectomies performed over a period of 25 years has been analysed to determine whether routine peroperative cholangiography (PC) has influenced overall mortality. The patients have been divided into four cohorts of 1000, the first cohort before the introduction of PC, two covering the period of introduction of PC and the final cohort when PC was an established routine. A significant fall in overall mortality has been demonstrated, but when the patients are divided into simple cholecystectomy and the group undergoing additional choledochotomy there is no significant fall in the mortality rate. The mortality rate for the latter group is three or four times greater than that for the cholecystectomy alone group. The main contribution to the lower mortality is the reduced duct exploration rate following the introduction of PC. The stone recovery rate has improved from 34 to 71 per cent. The use of routine PC during cholecystectomy is recommended.