Operative fluoroscopy and cholangiography: The use of modern radiologic technics during surgery

Operative cholangiography as currently performed in many hospitals in the United States may be a cumbersome procedure yielding less than optimal information. For maximal accuracy and diagnostic yield, operative radiographic examination of the biliary tract should include fluoroscopic observation and aimed spot films. The advantages gained by using modern radiologic equipment and technics are increased image clarity, increased capability for functional assessment of a dynamic system, increased efficiency, and decreased radiation hazard. In a series of 100 patients undergoing operative cholangiography by our technic, only one retained stone was demonstrated by postoperative studies. Five anomalies of the ductal system were easily identified and possible injury to the anomalous ducts averted. Considering the morbidity and mortality attendant upon inadequate or inappropriate biliary tract operations, investment in the sophisticated equipment necessary for optimal operative radiography is small indeed.