Exploration of the bile ducts is an operative procedure generally recognized to be fraught with difficulties. Instrumentation of the ducts is done blindly and, therefore, is often not definitive. Particularly difficult is the differentiation between tumor, stone, "spasm," and fibrosis at the sphincter of Oddi. Various diagnostic adjuncts, including intravenous cholangiography, operative cholangiography, and choledochoscopy, have been proposed for investigation of the biliary tract. However, the significant incidence of stones retained in the biliary tree after common duct exploration attests to the need for further technical improvement.
Duodenotomy with transampullary exploration of the bile ducts might be considered as one such technical improvement. This procedure is mandatory for the removal of many stones impacted at the ampulla of Vater and for visual inspection in the diagnosis of suspected tumors of this site. In addition it allows the surgeon to prove the passage of probes and dilators through the sphincter of