Since operative cholangiography was introduced by Mirizzi in 1932. Surgeons have used it routinely during cholecystectomy to find silent CBD stones. However, recent developments in preoperative evaluation techniques have led to debates regarding
the
routine use of operative cholangiography. The purpose of this study is to evaluate the necessity of the routine use of operative cholangiography.
Of the 839 patients who underwent cholecystectomy, 625 patients underwent preexploratory cholecystectomy during the period from June 1983 to December 1991, at the Department of Surgery, Yeungnam University Hospital. Unsuspected common duct stones
were
found in 5 out of 149 patients(5.9%) by preexploratoty cholangiography when emergency cholecystectomy was performed. Of the 448 cholangiography in patients without any abnormality in the preoperative test and no operative indication for CBD
exploration,
the incidence of gall stones was only 1.1%. Of the 82 patients with minor abnormality of LFT or ultrasonogram, 38 cases of elective cholecystectomy were carried out without any other test. The incidence of gall stones in these patients was 28%.
The
ERCP
was attempted on 163 patients with one or more of the following abnormalities : LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. In 117 of these patients, CBD stones were found, in 2 of the patients, stricture were
found,
and in the remaining 44, no stones were found, in 2 of the patients, stricture were found, and in the remaining 44, no stones were found, the ERCP performed on 35 patients with normal findings of preopeative LFT or ultrasonogram showed no
evidence
of
CBD stone. Of the 79 whose ERCP was judged normal preoperatively, no stones were found at operative cholangiography.
Therefore the following points may be concluded: First, operative cholangiography should be performed when emergency cholecystectomy is indicated. Secondly, it should also be done wen the confirmatory test, such as ERCP, PTC and CT was not
performed or
failed in patients with one or more of the following abnormalities such as LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. Finally, it should also be carried out on pa tients with dilated duct, small stones in the
gallbladder and enlarged cystic duct. (Korean J Gastroenterol 1994 ; 26 : 167~174)
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