The routine use of operative cystic duct cholangiography(OCDC) has been advocated by numerous authors. In these studies, the value of OCDC in the detection of unsuspected small stones of the common bile duct was demonstrated. The procedure also
appears
to be o value in reducing unnecessary exploration of the common bile duct in patients otherwise having clinical indications for such exploration. But opinion is divided as to whether cholangiography should be performed in all cholecystectomies or
only
in selected cases.
To determine the clinical usefulness of routine OCDC, we analyzed 307 patients undergoing cholecystectomy with routine OCDC for gallstone disease were retrospectively screened for the presence of 8 parameters of possible choledocholithiasis. Of
the
307
patients studied, 241 patients(78.5%) had a negative OCDC(group I), 22(7.1%) had false positive findings(group II), two (0.7%) had false negative findings(group III), and 42(13.7%) had findings positive for stones(group IV). In group I, 81
patients(33.6%) had one or more parameter of possible choledocholithiasis. In group II, 16 patients(72.7%) had one or more parameter. In group III, 2 patients(100%) had one or more parameter. In group IV, 5 patients(11.9%) without any positive
parameter
had choledocholithiasis. The sensitivity of OCDC was 95.5%, specificity 91.4%, efficiency 92.2%, predictability of a negative test 99.2%, predictability of a positive test 65.5%, and accuracy 92.8%. Routine OCDC showed unsuspected common bile
duct
stones in 5 patients(2.9%). Unnecessary common bile duct explorations were avoided in 81 of the 136 patients(59.5%). As a result of these findings, we recommend the use of OCCDC routinely in patients undergoing cholecystectomy. (Korean J
Gastroenterol
1994 ; 26 : 952-961).
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