End results after gall bladder operations with an analysis of the causes of residual symptoms

Abstract

A series of 165 patients who had 199 operations for biliary tract disease were studied on the average71/2 years after operation. I. End results of cholecystectomy. In a series of 136 patients who underwent cholecystectomy, 83% of those with calculous cholecystitis benefited from the operation and only 41% of those with non-calculous cholecystitis benefited. Where pre-operative colic was present and regardless if stones were found at operation, 76% benefited from cholecystectomy; with no pre-operative colic, only 41% were benefited. II. Causes of recurrent biliary symptoms in cholecystectomized patients. The causes for symptoms of marked degree include: residual biliary tract infection, biliary dyskinesia, common duct stones, chronic cholangitis and cystic duct stones. III. Extra- biliary causes for symptoms after cholecystectomy. (a) Mistakes in diagnosis. Long after cholecystectomy was performed the distress for which operation was performed was thought in retrospect to be due to one of the following conditions: peptic ulcer, neurosis, gastro-intestinal allergy, pelvic tuberculosis, pyelonephritis. (b) Appearance of abdominal symptoms due to new pathology. Patients who have undergone cholecystectomy are not immune to the general run of gastrointestinal diseases as duodenal ulcer, spastic colon and intestinal adhesions or to such general conditions as anxiety neurosis and endocrinopathy. These conditions may give biliary-like symptoms. IV. Associated Diseases. An average of 3.4 diseases was present in each of our patients who underwent biliary tract surgery. The diseases most commonly associated with pathology in the biliary tract were found to be degenerative vascular disease as coronary disease and essential hypertension, endocrine disturbances as menopause, hypothyroidism, hypopituitarism and obesity, diabetes mellitus, chronic hypertrophic arthritis, anxiety neurosis and the gastro-intestinal diseases listed above. V. The life time nature of biliary tract disease in some patients, the frequent repetition of the associated diseases listed above and the metabolic and endocrine background so often present suggest that biliary tract disease may be only one phase of a more fundamental and more inclusive disturbance. VI. Given a patient with a gall bladder scar and abdominal symptoms, careful analysis will show the symptoms to be due to (a) Persistent or recurrent biliary tract disease. (b) Extra-biliary disease, uncorrected by cholecystectomy because the original symptoms were due to pathology outside of the biliary tract. (c) The appearance of new abdominal pathology subsequent to and independent of the cholecystectomy.