Operative cholangiography. Review of 7,529 operations on the biliary tree in a community hospital.

Primary operation for cholelithiasis ranks third in frequency among general surgical procedures performed in this country each year [16]. The mortality and morbidity associated with retained common duct stones are apparent to all biliary surgeons. Although operative cholangiography is a standard procedure in many centers, some still use this adjunct to biliary surgery infrequently, as shown by the 51 percent performance rate in the present study. However, the literature is replete with evidence supporting the routine use of cholangiography. In the present report positive findings on common duct exploration almost doubled when operative cholangiography was added to the clinical and operative criteria for common duct exploration. Our experience indicates that common duct exploration is not always required when the patient has jaundice if normal operative cholangiograms support the patient's history and other laboratory findings. Cholangiography was also found to be accurate in the five cases in which a secondary biliary procedure had to be performed.

Cholecystectomy with closed suction drainage.

In this prospective, consecutive, and nonrandomized study, 200 patients had cholecystectomy in a seven-month period. Half of them had drainage with Penrose drains and the other half with a closed suction system. The average hospitalization was one day shorter in the latter. No complications related to its use were found. Retrospective evaluation appears to indicate some conservation of medical care expenditures.