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April 1979

Operative Cholangiography and Overlooked Stones-Reply

Author Affiliations

Lexington, Ky

Arch Surg. 1979;114(4):549. doi:10.1001/archsurg.1979.01370280203037

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In Reply.–As I viewed my task, it was to comment on the misuse of operation cholangiography, although I might have mentioned choledochoscopy as an alternative method of discovering stones in the common bile duct. I would have made the same point regarding its use, namely, that it is only as good as the surgeon who uses it. On that point, I am unaware of any study that clearly shows the superiority of choledochoscopy over properly performed operation cholangiography. I hope that enthusiasts will conduct such a trial.

I must take issue with Shapiro and Finnis that choledochoscopy obviates operation cholangiography. The present rigid equipment is useful in detecting stones between the confluence of the hepatic ducts and the papilla; it is also useful in determining whether an obstruction on cholangiography is a calculus or tumor. However, until suitable flexible equipment is developed, choledochoscopy cannot detect stones in the interhepatic

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