Diagnostic cholangioscopy--comparison with conventional methods (radiology, ultrasonography).

The goals of surgery for calculous biliary disease are to explore as few normal bile ducts as possible and to remove all calculi. The most commonly used techniques to help eliminate residual stones are: exploration of all or most common ducts; operative cholangiography; intraoperative ultrasonography or choledochoscopy. Exploration of common bile ducts on clinical diagnoses leads to high number of negative explorations and has been abandoned. Operative cholangiography performed with modern technique with the use of fluoroscopy is very accurate with a diagnostic accuracy of well above 95%. Cholangiography can be performed preoperatively with the same diagnostic accuracy and thereby save operative time. Intraoperative ultrasonography has recently been introduced for the diagnosis of residual stones and seems to be superior to cholangiography. It is of limited use however, for intrahepatic stones. Intraoperative choledochoscopy finally is the most superior way of achieving intraoperative diagnosis of common bile duct stones. With the advances of ERC and other non-operative techniques, the consequences of leaving calculi in the bile duct are less severe today than before. Non-operative retrieval by percutaneous, endoscopic means or chemical dissolution are effective ways of dealing with residual stones.