Biliary tract surgery concomitant with other intra-abdominal operations

Biliary tract operations were performed in conjunction with another intra-abdominal operation in 253 patients. Of this group, 137 patients had unplanned or "incidental" biliary procedures, with a morbidity rate of 15% and a mortality rate of 7%. Three of the 20 nonfatal complications were related to the biliary tract surgery. A planned biliary tract operation concomitant with another intra-abdominal procedure was performed in 65 patients, with a morbidity rate of 20% and mortality rate of 2%. None of these postoperative complications or deaths were attributed to the biliary tract operation. A planned biliary tract procedure plus another incidental and unplanned operation were performed in 51 patients, with a morbidity rate of 11.8% and no deaths. The complications were not specific to the biliary tract operation. The data suggest that it is feasible to perform concomitant cholecystectomy for cholecystostomy for calculous biliary tract disease in patients operated on for nonbiliary diseases. It is also reasonable to perform definitive surgery for most gastrointestinal diseases discovered incidental to a planned cholecystectomy. These recommendations are valid only if the condition of the patient permits the additional operative stress and the exposure is adequate to perform a safe procedure on the gallbladder. Concomitant operations that require choledochotomy are not recommended, except under unusual circumstances.