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An Argument

Michael D. Pasquale, MD; Russell J. Nauta, MD

Arch Surg. 1989;124(9):1041-1042.

Abstract
• We reviewed the course of 314 patients who underwent cholecystectomy at a University Hospital in 1985. Two hundred eighty-five patients underwent cholecystectomy for cholelithiasis. Preoperatively elevated liver function test results, history of jaundice or pancreatitis, or operative findings of palpable common bile duct stone or dilated extrahepatic ducts were criteria for indicated cholangiography. Of 142 patients who had cholangiography with negative results, only 31 were indicated by these criteria. In 93 patients not having cholangiography performed, the criteria were met in only 8 patients. Of 38 patients who underwent common bile duct exploration, only 29 had stones. As operative time, morbidity, and cost were demonstrably increased in patients undergoing cholangiography, a selective approach is advocated. The number of unnecessary common bile duct explorations might be cut by almost half, while the incidence of finding clinically unsuspected yet significant common bile duct stones is negligible.

(Arch Surg. 1989;124:1041-1042)

Author Affiliations
From the Department of Surgery, Georgetown University School of Medicine, Washington, DC.

Footnotes
Accepted for publication December 12, 1988.

Presented at the Second World Congress on Hepato-Pancreato-Biliary Surgery, Amsterdam, the Netherlands, June 16, 1988.

Reprint requests to Department of Surgery, Georgetown University School of Medicine, 3800 Reservoir Rd NW, Washington, DC 20007 (Dr Nauta).

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