Routine operative cholangiography with cholecystectomy.

Four hundred and forty patients who underwent cholecystectomy and routine operative cholangiography were reviewed. False-positive and false-negative examination were 3.8 and 0.2 per cent, respectively. Unsuspected common duct stones were found 0.9 per cent of the time by cholangiography. The yield of common duct exploration was 63.8 per cent. Operative cholangiography spares at least two-thirds of the patients with clinical indications of choledocholithiasis unnecessary common duct explorations. The yield of operative cholangiography in patients with no clinical indication of choledocholithiasis is extremely low, and the cost-to-benefit ratio of routine operative cholangiography is high. Operative cholangiography should be used prior to common duct exploration for any clinical suspicion of common duct pathology. Routine operative cholangiography is not indicated for those patients with no clinical indication of common duct pathology.