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KMID : 0371319680100030169
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Journal of the Korean Surgical Society
1968 Volume.10 No. 3 p.169 ~ p.176
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Clinical Study of the Surgical Treatment of Nonmalignant Biliary Tract Disease
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Abstract
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This report is a review of our experience of 408 patients with biliary tract disease on whom I have operated at the Pusan National Medical College and in other clinics during the ten years and seven months between October 1956 and May 1967.
Nonmalignant biliary tract disease was the commonest cause for the underataking of abdominal surgery. In spite of adequate treatment recurrences were frequent and of a greater severity than the original attack prior to surgical intervention and in some cases resulted in the death of the patient. The purpose of this paper is to present more detailed observations of these cases.
The pathological conditions requiting surgical intervention in these 408 patients were:
Cholecystitis with stones 162 patients
Cholecystitis without stones 204 patients
Ascariasis or clonorchiasis sinnensis in biliary system 12 patients
Congenital biliary tract atresia 10 patients
Miscellaneous 20 patients
The operative procedures and post-operative deaths were as follows:
Emergency Elective
Patients Deaths Patients Deaths
Cholecystectomy 82 4 91 2
Cholecystectomy with common duct exploration 43 4 94 3
with common duct exploration and duodenostomy 14 2 20 2
with common duct exploration, duodenostomy
& sphincterotomy 5 1 15 2
Cholecystectomy only 10 0 2 0
with common duct exploration 2 1 10 1
Other procedurse 20 1
TOTALS: 156 12 252 11
A survey of 408 operations undertaken for nonmalignant biliary disease is reported and the following conclusions are drawn:
1. The mortality increased progressively with increasing age groups reached-10.86% for those patients in the age group 60-69 years of age. With the exception of one case of congenital biliary tract atresia there were no deaths in patients aged under 30 years.
2. The overall mortality in the series was 5.75%. The mortality following emergency surgery was 7.89% and 4.36% following elective surgery.
3. The mortality rate for emergency cholecystectomy was twice that for elective cholecystectomy.
4. The mortality rate following an emergency exploration of the common bile duct was 1.5 times that following an elective exploration.
5. The mortality rate for emergency cholecystectomy with common duct exploration was five times as great as that following a similar elective procedure.
6. A calulus was found in 71% of patients with jaundice, 52% of patiets with dilated common duct, and 55% of the patients with small stone, in whom the common bile duct was explored.
7. The mortality was lowest with a simple cholecystectomy and increased with additional surgical procedures.
8. Of 23 deaths, excluding 10 paitents in whom death was due to peritonitis, hepatic failure was the most important cause of death accounting for 8 out of 13 deaths.
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