Transcystic duct operative cholangiography was performed in 423 of 506 consecutive cholecystectomies. Patients were classified prospectively as having or not having a preoperative clinical indication for common duct exploration on the basis of jaundice, pancreatitis, or an elevated alkaline phosphatase level. Cholangiography avoids consideration of classical intraoperative indications for common duct exploration.
Thirty-nine of 79 patients, or 50%, with positive preoperative clinical indications for common duct exploration had normal cholangiograms, and were spared exploration of the common duct by operative cholangiography. Of 427 patients without clinical indications for duct exploration, unsuspected common duct stones were demonstrated in eight, or 1.8%. Routine operative cholangiography reduced the number of common duct explorations to 11.1% of cholecystectomies, and reduced negative common duct explorations to 3.2%. This experience suggests that the indication for operative cholangiography is "cholecystectomy."