Clinical reliability of perioperative fluorocholangiography

The use of mobile image intensifier and television monitor permits easy performance of direct visualization of the biliary tract during surgery (fluorocholangiography). The routine use of fluorocholangiography has certain advantages over the standard technique of operative cholangiography: rapid direct visualization permits proper positioning of the instrument and the patient, thus many pitfalls can be avoided (gas, air bubbles, superposition of bone structures); multiple exposures at varying angles can be obtained if suspicious areas are seen; the intrahepatic ducts can be fully visualized; the functioning of the sphincter can be evaluated under direct vision; and direct visualization permits considerable time savings. In this study, operative cholangiography was routinely performed on 1,600 consecutive operations on the biliary tract using this technique. The reliability of operative fluorocholangiography was evaluated and compared to other published forms of operative cholangiography. The principal conclusions of the authors are as follows: the false-positive results of operative fluorocholangiography are 16.8% (57 of 339 common bile ducts explored, 57 of 1,600 cholangiographies); 22 retained stones were subsequently found in the 1,600 patients; the reliability of operative fluorocholangiography is, therefore, approximately 95%; and operative fluorocholangiography is superior to conventional cholangiography, and its routine use contributes significantly to the reduction of the rate of negative choledochal explorations and residual stones.