Cholecystectomy: clinical experience with a large series

This large series of 1,035 consecutive operations with a primary diagnosis of inflammatory or calculus disease of the gallbladder included a large number of elderly patients with the greatest incidence in the seventh and eighth decades of life. Operation was performed after initial stabilization when acute illness presented and without prolonged delay of medical treatment. Cholecystectomy was almost always able to be performed successfully at the initial operation. This approach produced low rates of morbidity and mortality when compared with reports from large university centers and with reports advocating delayed operation for acute cholecystitis or planned cholecystostomy in elderly and high risk patients. Operative cholangiograms were rarely performed and rates of residual or retained common duct stones were low. Length of hospital stay was related to age and performance of a common duct exploration. Draining the subhepatic space routinely by way of a separate peritoneal stab incision and removing the drain within 48 hours produced a low rate of wound complications.