Summary
A series of 165 patients who had 199 operations for biliary tract disease were studied on the average71/2 years after operation.
-
I.
End results of cholecystectomy. In a series of 136 patients who underwent cholecystectomy, 83% of those with calculous cholecystitis benefited from the operation and only 41% of those with non-calculous cholecystitis benefited. Where pre-operative colic was present and regardless if stones were found at operation, 76% benefited from cholecystectomy; with no pre-operative colic, only 41% were benefited.
-
II.
Causes of recurrent biliary symptoms in cholecystectomized patients. The causes for symptoms of marked degree include: residual biliary tract infection, biliary dyskinesia, common duct stones, chronic cholangitis and cystic duct stones.
-
III.
Extra- biliary causes for symptoms after cholecystectomy.
-
(a)
Mistakes in diagnosis. Long after cholecystectomy was performed the distress for which operation was performed was thought in retrospect to be due to one of the following conditions: peptic ulcer, neurosis, gastro-intestinal allergy, pelvic tuberculosis, pyelonephritis.
-
(b)
Appearance of abdominal symptoms due to new pathology. Patients who have undergone cholecystectomy are not immune to the general run of gastrointestinal diseases as duodenal ulcer, spastic colon and intestinal adhesions or to such general conditions as anxiety neurosis and endocrinopathy. These conditions may give biliary-like symptoms.
-
IV.
Associated Diseases. An average of 3.4 diseases was present in each of our patients who underwent biliary tract surgery. The diseases most commonly associated with pathology in the biliary tract were found to be degenerative vascular disease as coronary disease and essential hypertension, endocrine disturbances as menopause, hypothyroidism, hypopituitarism and obesity, diabetes mellitus, chronic hypertrophic arthritis, anxiety neurosis and the gastro-intestinal diseases listed above.
-
V.
The life time nature of biliary tract disease in some patients, the frequent repetition of the associated diseases listed above and the metabolic and endocrine background so often present suggest that biliary tract disease may be only one phase of a more fundamental and more inclusive disturbance.
-
VI.
Given a patient with a gall bladder scar and abdominal symptoms, careful analysis will show the symptoms to be due to
-
(a)
Persistent or recurrent biliary tract disease.
-
(b)
Extra-biliary disease, uncorrected by cholecystectomy because the original symptoms were due to pathology outside of the biliary tract.
-
(c)
The appearance of new abdominal pathology subsequent to and independent of the cholecystectomy.
Similar content being viewed by others
References
Graham, E. A. and Mackey, W. A.: A Consideration of the Stoneless Gall Bladder.J. A. M. A., 103 :1497–1499, Nov. 17, 1934.
Deaver, J. B. and Bortz, E. L.: Gall Bladder Disease; a Review of 903 Cases.J. A. M. A., 88 :619–623, Feb. 26, 1927.
Kunath, C. A.: The Stoneless Gall Bladder.J. A. M. A., 109:183- 187, July 17, 1937.
Maynard, C. W.: Cholecystectomy as Seen by the Surgical Pathologist.Am. J. Clin. Path. 3:339–345, Sept., 1933.
Judd, E. S. and Priestley, J. T.: Ultimate Results from Operations on the Biliary Tract.J. A. M. A., 99:887–891, Sept. 10, 1932.
Wilson, W. D., Lehman, E. P. and Goodwin, W. H.: Prognosis in Gall Bladder Surgery.J. A. M. A., 106:2209–2213, June 27, 1836.
Muller, Geo. P.: Non-calculous Gall Bladder.J. A. M. A., 89:786- 789, Sept. 3, 1927.
Cattell, R. B.: End Results of Surgery of the Biliary Tract.Annals of Surgery, 89 :930–941, June, 1929.
Wilkinson, S. A.: Chronic Cholecystitis Versus Irritable Colon.J. A. M. A., 109:1012–1016, Sept. 25, 1937.
Stanton, E. M.: Stoneless Gall Bladder.Am. J. Surg., 18:246- 250, Nov., 1932.
Ravdin, I. S., Riegel, C, Johnston, C. G. and Morrison, P. J.: Studies in Biliary Tract Disease.J. A. M. A., 103:1504–1509, Nov. 17, 1934.
Agrifoglio, Mario: Influenza della colecistectomia sulla funzione e struttura del pancreas e sull’assorbimento alimentare.Polioclinico, (Sez. chir.), 35:397–416, Aug., 1928. Quoted by Sanders, R. L. : End Results in Five Hundred Cases of Cholecystectomy.Ann. Surg., 92:376–387, Sept., 1930.
Scott, A. C, Jr.: Modern Management of Gall Bladder Disease.Texas State J. Med., 30 :434–437, Nov., 1934.
Greene, C. H., Twiss, J. R. and Carter, R. F.: Biliary Stasis.Am. J. Digest. Dis. and Nutrit., 3:622–624, Nov., 1936.
Brown, C. F. G. and Dolkart, R. E.: Keto-cholanic Acids in the Medical Management of Low Grade Gall Bladder Disease.J. A. M. A., 108:458–461, Feb. 6, 1937.
Ivy, A. C. and Sandblom, P.: Biliary Dyskinesia.Ann. Int. Med., 8:115–122, Aug., 1934.
McGowan, J. M., Butsch, S. L. and Walters, W.: Pressure in the Common Bile Duct of Man.J. A. M. A., 106:2227–2230, June 27, 1936.
Weir, J. F. and Snell, A. M.: Symptoms That Persist After Cholecystectomy.J. A. M. A., 105:1093–1098, Oct. 5, 1935.
Judd, E. S.: Condition of the Common Duct After Cholecystectomy.J. A. M. A., 81:704–709, Sept. 1, 1923.
Rehfuss, M. E. and Nelson, G. M.: The Medical Treatment of Gall Bladder Disease. W. B. Saunders Co., Phila, 1935.
Lahey, F. H. and Jordan, S. M.: Management of Biliary Tract Disease.Am. J. Surg., 11:1–5, Jan., 1931.
Laird, E. G.: The Co-incidence of Cholecystitis and Peptic Ulcer.New England J. Med., 213:764–767, Oct. 17, 1935.
McVicar, C. S. and Weir, J. F.: Association of Gall Stones and Ulcer.Med. Clin. N. Amer., 12:1521–1633, May, 1929.
Bruce, H. A.: Association of Cholecystitis with Duodenal Ulcer.Ann. Surg., 84:387–391, Sept., 1926.
Judd, E. S.: Bleeding Ulcer of the Duodenum Associated with Cholecystitis.Ann. Surg., 75:459–466, April, 1922.
Miller, T. G.: Gall Bladder Disease.Pennsylvania M. J., 37:996- 1000, Sept., 1934.
Pancoast, Henry K.: Discussion of paper of Miller (26).
Wilkie, D. P. D.: Indications for Surgical Treatment in Peptic Ulcer.Brit. M. J., 1:771–774, May 6, 1933.
Christopher, Frederick, ed.: A Textbook of Surgery. Phila., W. B. Saunders Co., p. 1315, 1936.
Lahey, F. H.: Cholecystitis, the Cholesteral Gall Bladder and Silent Gall Stones.Boston M. and S. J., 196:677–681, April 28, 1927.
Meyers, S. G. and Sandweiss, D. J.: The Clinic Patient.Internat. Clin., 2:166–174, June, 1931.
Johnston, Chas. G.:Journal of Wayne U. College of Med., 1:3, 1937.
Additional information
From the North End Clinic, Detroit
Rights and permissions
About this article
Cite this article
Meyers, S.G., Sandweiss, D.J. & Saltzstein, H.C. End results after gall bladder operations with an analysis of the causes of residual symptoms. American Journal of Digestive Diseases 5, 667–674 (1938). https://doi.org/10.1007/BF02996596
Issue Date:
DOI: https://doi.org/10.1007/BF02996596