Evaluation of operative choledochoscopy

The accuracy of choledochoscopy in demonstrating calculi of the common bile duct has been assessed from 121 examinations with the rigid choledochoscope by 13 different surgeons. Choledochoscopy was used before an exploratory procedure in 48 patients and was without error in 45, but the procedure is not recommended because of the risks of unncessary choledochotomy. Postexploratory choledochoscopy was used in 73 patients. A correct diagnosis of the presence or absence of stones was provided in 64 patients, including unsuspected stones in 13. However, stones were missed in nine patients. When postexploratory T-tube cholangiography was combined with choledochoscopy, there were no diagnostic errors. It is concluded that, in all patients, after choledochotomy, choledochoscopy should be combined with cholangiography.