Routine or selective intraoperative cholangiography.

IOC is definitely indicated in patients with clinical indications. It avoided unnecessary exploration of the common bile duct in 32.7 per cent. Of all the clinical indications, palpable common bile duct stone was the most accurate. Dilated common bile duct, dilated cystic duct, elevated serum alkaline phosphatase, multiple small stones and positive imaging investigations were a statistically significant prediction of common bile duct stones. IOC is not justified in patients without clinical indications because of the low incidence of unsuspected common bile duct stone (0.66%) and on the basis of cost-effectiveness. The results support the view that IOC is invaluable and should be used selectively.