Cholelithiasis in a teaching hospital: a review of clinical and post-mortem experiences

Six hundred and eighty cadavers and 307 patients with gallstones who presented over a three-year period at a WA teaching hospital were studied to assess the prevalence, morbidity and mortality of cholelithiasis. In particular, the outcome of surgical treatment compared with that of conservative treatment was assessed. In the post-mortem series, 17.9%, of men and 29.7% of women either had gallstones or had undergone a cholecystectomy previously. In 12 patients (1.8% of patients over all or 10% of those patients with gallstones), the gallstones were responsible for the death of the patient. In the clinical series, of the 248 patients who were treated surgically, 68 patients suffered one or more non-specific postoperative complications and 10 patients suffered specific postoperative complications. However, only one (0.4% operative mortality) postoperative death occurred, the result of a stroke in a patient with previously-known cerebrovascular disease. Of the 59 patients whose gallstones were treated conservatively, 16 patients developed further complications of cholelithiasis with one patient dying of renal failure that was subsequent to biliary pancreatitis. This study shows that to perform cholecystectomy at an early stage in patients with biliary pain is safe and can abort the progression to more-serious complications.