300 consecutive cholecystectomies performed from 1984 through 1986 were studied retrospectively to answer the following questions: which are suitable preoperative indicators for selective operative cholangiography, and which is the failure rate to detect biliary concrements by selective cholangiography? Patients with a history of jaundice, suspected concrements from preoperative intravenous cholangiography or ultrasound examination, a common bile duct wider than 8 mm, and elevated serum levels of bilirubin, alkaline phosphatase, ALAT (GPT) or ASAT (GOT) all had significantly higher rates of biliary concrements. Of these indicators, preoperative radiologic studies, serum levels of ALAT (GPT) and serum levels of alkaline phosphatase showed the best sensitivity, specificity as well as positive and negative predictive value. If two criteria, preoperative radiology and serum levels of ALAT (GPT), had been used, intraoperative cholangiography would have been performed in 34% of the cases. 82% of all biliary concrements would have been detected; in 3% of all cholecystectomies, the diagnosis of concrements would have been missed. We conclude that prospective studies should be performed to better define necessity and benefit of routine operative cholangiography still widely performed today.
