Perforation of the gallbladder. A retrospective comparative study of cases from 1946-1956 and 1969-1980

The records of patients treated for perforation of the gallbladder in 1946-1956 or 1969-1980 (n = 41 and 70) were reviewed to elucidate if changed strategy in acute cholecystitis, i.e. delayed vs. early surgery, had had any effect on the prognosis. The overall mortality declined significantly between the two periods, from 20 to 7%. The mortality was lowest (6%) after cholecystectomy, as compared with cholecystostomy (29%) and conservative treatment (67%). The frequency of chronic biliary fistula, calculated on all gallbladder perforations, decreased significantly (46 vs. 27%), but the frequency of acute free perforation was similar in both periods (27 and 34%). Treatment policy in acute cholecystitis is discussed. The study indicated that early surgery (Cholecystectomy with peroperative cholangiography and, if required, choledochotomy) is the treatment of choice, giving the best results also in patients with perforation of the gallbladder.