Choledochoscopy as a complementary procedure to operative cholangiography in biliary surgery

Six years' experience with the use of the flexible choledochoscope for biliary surgery is reported. One hundred forty-nine patients underwent common bile duct exploration with choledochoscopy as a complementary procedure. Choledochoscopy immediately showed the absence of stones in 37 patients in whom stones were suspected but the results of preexploratory operative cholangiography were negative or equivocal. The remaining 112 patients underwent choledocholithotomy with choledochoscopy. Only two patients (1.3 percent) returned with unsuspected residual stones. Choledochoscopy used as a complementary procedure to operative cholangiography can easily and more accurately clarify suspicious findings in the operative cholangiogram. It avoids the use of blind instrumental exploration of the bile ducts. Impacted stones can be extracted easily under direct vision with the choledochoscope. We believe that the use of choledochoscopy contributed to our low incidence of retained stones.