Concept: When to Remove the Gallbladder
Despite the potential risk of surgical errors, which may produce complications of a horrendous nature, cholecystectomy in the hands of a skilled surgical team is followed by a remarkably low mortality rate. In a review of 1,100 cholecystectomies without common bile duct (CBD) exploration performed (1969–1980) for nonmalignant gallbladder disease, including acute cholecystitis, by the residents and staff of the Booth Memorial Medical Center in Flushing, New York, the hospital mortality was 0.25%. Martin and van Heerden reported a 0.3% rate for 586 cholecystectomies for chronic cholecystitis and 2.1% for acute cholecystitis. McSherry and Glenn found a 0.5% hospital mortality rate following cholecystectomy for chronic disease of the biliary tract; in patients under age 50 the mortality rate was 0.1%, while those over age 50 experienced a rate of 0.9%. In studying cholecystectomy for acute cholecystitis, the same authors found a mortality rate of 1.3% for the entire group of 1,643 cases: under age 50, 0.4% died while over age 50 the rate was 2.2%. These authors surveyed 11,808 patients who underwent surgery from 1932 to 1978. It is our experience that in the modern era improved monitoring of cardiorespiratory dynamics has markedly reduced the risk of elective surgery in the aged population, and we did not find a significant increase in the fatality rate after cholecystectomy in the patients over 50 as compared to those under the age of 50.
KeywordsAcute Pancreatitis Common Bile Duct Cystic Duct Acute Cholecystitis Common Bile Duct Stone
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