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[What is the contribution of surgery in cholelithiasis today?]
M Kocher1, U Herzog, J P Schuppisser
1Allgemeinchirurgische Abteilung, St. Claraspital, Basel.
Insights
Cholelithiasis surgery, specifically cholecystectomy, demonstrates low mortality (0.18%) and reintervention rates (1.3%). This procedure remains the standard treatment for gallstones due to its safety profile.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Outcomes Research
Context:
- Analysis of surgical outcomes for cholelithiasis (gallstones) between 1984-1989.
- Evaluation of mortality and reintervention rates in a cohort of 1631 patients.
Purpose:
- To assess the safety and efficacy of cholecystectomy as a treatment for cholelithiasis.
- To determine the overall mortality and reintervention rates associated with surgical management of gallstones.
Summary:
- Cholecystectomy in 1357 patients had a mortality of 0.07%. Common bile duct exploration increased mortality to 0.9%. Transduodenal papillotomy or biliodigestive anastomosis in 57 patients had no deaths.
- Overall mortality was 0.18%, with higher rates in patients over 60 (0.4%). Acute gallbladder inflammation did not increase mortality.
- Reinterventions were required in 1.3% of cases, most commonly for retained common duct stones treated by endoscopic sphincterotomy (0.86%). Operative injury to the common duct occurred in 0.6%.
Impact:
- Cholecystectomy is confirmed as the standard treatment for cholelithiasis due to its low mortality and reintervention rates.
- The study provides valuable data on surgical risks and complications associated with gallstone management.
- Findings support the continued use of cholecystectomy in clinical practice for gallstone disease.
Abstract:
1631 patients with cholelithiasis were operated on between 1984 and 1989 at the St. Clara Hospital in Basel. Mortality and rate of reinterventions were evaluated. 1357 patients had cholecystectomy with a mortality of 0.07%, 217 patients needed an exploration of the common bile duct, which increased the mortality rate to 0.9%. 57 patients had a transduodenal papillotomy, biliodigestive anastomosis or a reoperation without any death. The overall mortality was 0.18%. The mortality for patients over 60 years was 0.4%, there were no deaths for patients under 60 years. The mortality did not increase when there was an acute inflammation of the gallbladder. Reinterventions had to be done in 1.3%. The most common reason for reoperation was a retained common duct stone, which was then removed by endoscopic sphincterotomy (0.86%). Operative injury of the common duct occurred in 0.6% (1 of 1631 patients). Cholecystectomy is still standard treatment of cholelithiasis because of its low mortality and reintervention rate.