Cholecystectomy.

Cholecystectomy is second only to appendicectomy as the most commonly performed abdominal operation.' Consequently it is not surprising that there have been many studies of large series of patients undergoing this procedure" Surgery of the common bile duct has received almost as much attention in published work, with the indications for duct exploration being at the centre of the discussion.45 Most authors agree that the clinical indications for choledochotomy are a history of jaundice, colic, rigors, or pancreatitis, and the operative findings palpable choledochal stones, a dilated or thickened common duct, or multiple small stones in the gall bladd-r. It is generally accented, however, that when the decision whether or not to perform choledochotomy is based on clinical grounds alone there is a 10''!, incidence of residual stones and a 50%/, incidence of fruitless choledochotomy.6 I Choledochotomy when added to cholecystectomv trioles the mortality rate, whether or not stones are found.4 I Obviously, therefore, fruitless choledochotomy should be avoided whenever possible. Since the introduction of operative cholangiography in 1931 by Miriz7i it has become anoarent that this technique might help to reduce the morbidity and mortality associated with cholecystectomy and choledochotomy both by preventing the presence of choledochal stones being overlooked and by reducing the necessity to open the duct when there were no stones.9 Some authorities believe, however, that operative cholangiography should never become a substitute for clinical appraisal, and a negative cholangiogram should not deter one from opening the duct if there is a sound clinical reason.10 Two series of patients undergoing cholecystectomy in the United Birmingham Hospitals are compared in this report. The first group were operated on between 1955 and 1959, at a time when operative cholangiography was used infrequently, and the second between 1960 and 1970 when this technique was being performed in most cases. The results are analysed in an attempt to evaluate the effects of ooerative cholangiography on the incidence of fruitless choledochotomy-that is, choledochotomy with no stones and no duct abnormalityand the proportion of cases in which stones are found. The complications of fruitless choledochotomy, the incidence of reoperation, and the causes of death in the series are also assessed.