A selective approach to operative cholangiography.

The value of operative cholangiography in the detection of common bile duct stones has been documented in a number of studies. This study suggests that operative cholangiography can be-used successfully on a more selective basis when used in conjunction with laboratory and operative criteria. One hundred and fifty patients who underwent routine cholecystectomy were retrospectively evaluated. Seventy-five percent had a normal cholangiogram and normal levels of bilirubin and alkaline phosphatase. The remaining 25% had abnormal cholangiograms as well as abnormal laboratory chemistry values. It was noted that if selective operative cholangiography had been performed only on those patients with indications for common bile duct exploration, no ductal stones would have been omitted. Based on these data, a selective approach to operative cholangiography is advocated.