Technical aspects of bile duct evaluation and exploration.

Choledocholithiasis is a common manifestation of biliary disease. Intraoperative cholangiography can be performed in several ways. Common bile duct exploration can be safely performed but necessitates an advanced level of surgical experience to limit complications and improve success. An algorithm based on available resources and the physician skill set is vital for safe and effective management of choledocholithiasis. Endoscopic retrograde cholangiopancreatography requires the availability of an advanced endoscopist as well as significant equipment and resources. Current training of young surgeons is limited for open biliary procedures and common bile duct explorations. Educational guidelines are necessary to reduce this educational gap.