The surgical treatment of biliary tract disease
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Pathologically acute cholecystitis is frequently a progressive lesion proceeding to gangrene and perforation.
The severity of the lesion in the individual case is usually not predictable from the clinical symptoms and signs.
The mortality from cholecystectomy in the presence of the acute lesion without complications is very low and becomes progressively greater when gangrene and perforation occur.
The danger of operating on the patient in the acute stage before gangrene and perforation is considerably less than the danger of development of gangrene and perforation with their attendant high mortality.
Consideration of its primary mortality, subsequent morbidity, high percentage necessity for reoperation and high mortality at subsequent reoperation eliminates cholecystostomy from consideration in the treatment of acute cholecystitis.
Our observations confirm the opinions of those who have advocated early operation in acute cholecystitis, among whom are notably Walton (7), Bland-Sutton (8), Kirschner (9), Crile (10), Miller (11), Alexander (12), Graham (13), Mentzer (14), Zinninger (15), Judd and Phillips (16), Stone and Owings (17), and particularly Heuer (18), whose analysis is probably the best to date.
KeywordsCholecystitis Gall Bladder Acute Cholecystitis Choledocholithiasis Common Duct
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