April 1992

Intraoperative Cholangiography Revisited

Author Affiliations

From the Department of Surgery, Long Island Jewish Medical Center Affiliation at Queens Hospital Center, Jamaica, NY (Drs Pace, Cosgrove, and Margolis); and the Departments of Surgery (Drs Pace, Cosgrove, and Margolis) and Epidemiology and Social Medicine (Dr Breuer), Albert Einstein College of Medicine, Bronx, NY.

Arch Surg. 1992;127(4):448-450. doi:10.1001/archsurg.1992.01420040094016

• The charts of 1351 patients undergoing cholecystectomy at our institutions from 1985 through 1989 were reviewed retrospectively to evaluate the indications for and the success of intraoperative cholangiography. A total of 800 patients underwent intraoperative cholangiography. They were divided into two groups based on the absence (CR−) or presence (CR+) of clinical and/or operative criteria suggestive of the existence of common bile duct stones. Intraoperative cholangiography in CR− patients was of limited benefit, being negative (normal) in 95.7%, true-positive (abnormal) in 3.3%, and false-positive in 1%. False-positive intraoperative cholangiography resulted in unnecessary common bile duct explorations. Intraoperative cholangiography in CR+ patients proved useful, avoiding unnecessary common bile duct exploration in 55%. In those select CR+ patients with palpable common bile duct stones or cholangitis, little additional information was gained by the intraoperative cholangiography. We conclude that routine screening intraoperative cholangiography in CR− patients be reconsidered, as should the use of intraoperative cholangiography in CR+ patients with a palpable common bile duct stone or cholangitis. Intraoperative cholangiography in the remainder of CR+ patients proved beneficial and should be continued.

(Arch Surg. 1992;127:448-450)