The case against routine operative cholangiography.

We reviewed 500 consecutive cholecystectomies during which operative cholangiography was performed only when there were clinical indications for common duct exploration. Negative operative cholangiograms obviated the necessity for exploration in a substantial number of cases. Cholecystectomy without operative cholangiography was performed in 438 patients. From the average experience of those employing routine cholangiography (6 percent incidence of unsuspected stones), we presumably missed common duct stones in about 26 patients, but those stones either passed spontaneously or caused no problems. A single patient requiring reoperation for a retained stone was not a candidate for cholangiography at the original operation. No common duct injuries occurred in the series. We conclude that routine operative cholangiography is unnecessary for either finding unsuspected common duct stones or detecting ductal anomalies.