Summary
The goals of surgery for calculous biliary disease are to explore as few normal bile
ducts as possible and to remove all calculi. The most commonly used techniques to
help eliminate residual stones are: exploration of all or most common ducts; operative
cholangiography; intraoperative ultrasonography or choledochoscopy. Exploration of
common bile ducts on clinical diagnoses leads to high number of negative explorations
and has been abandoned. Operative cholangiography performed with modern technique
with the use of fluoroscopy is very accurate with a diagnostic accuracy of well above
95 %. Cholangiography can be performed preoperatively with the same diagnostic accuracy
and thereby save operative time. Intraoperative ultrasonography has recently been
introduced for the diagnosis of residual stones and seems to be superior to cholangiography.
It is of limited use however, for intrahepatic stones. Intraoperative choledochoscopy
finally is the most superior way of achieving intraoperative diagnosis of common bile
duct stones. With the advances of ERC and other non-operative techniques, the consequences
of leaving calculi in the bile duct are less severe today than before. Non-operative
retrieval by percutaneous, endoscopic means or chemical dissolution are effective
ways of dealing with residual stones.
Key words:
Common bile duct stones - Common bile duct exploration - Operative cholangiography
- Ultrasonography - Choledochoscopy
