[What does surgery in cholelithiasis accomplish today?]

Cholecystectomy is the only definitive treatment of gallbladder stones. This procedure thus remains the standard with which alternative treatment modalities have to be compared. The comparison must take into account the most recent surgical results, as much progress has been made in the past twenty years by improved perioperative management, wider use of antibiotics, earlier timing of operation, etc. The result achieved at the surgical clinic of the St-Claraspital in Basle over a 6-year period (1984-1989) may serve as an example of such progress: 1631 operative procedures for biliary stones resulted in an overall mortality of 0.18%. Mortality of simple cholecystectomy was 0.07% (in patients below 60 years of age 0%). 0.9% of patients undergoing cholecystectomy and common duct exploration died (0% of patients below 60 years of age). Comparison of two time periods (1972-80 and 1984-89) reveals a decrease in mortality by a factor of 3-4 and a decrease in morbidity by a factor of 2. The late results of biliary surgery are also satisfactory. In a prospective survey at the St-Claraspital 90.6% of all surgical patients were well one year postoperatively. An organic biliary pathology was only rarely responsible for the complaints in symptomatic patients. An extrabiliary organic or functional pathology is the usual cause of late postoperative symptoms. Such pathology frequently exists before the biliary procedure and therefore has no connection with the biliary disease or the operation performed.(ABSTRACT TRUNCATED AT 250 WORDS)