Trends in surgical treatment of calculous disease of the biliary tract.

From the data presented, there are five distinct trends in operations for calculous biliary tract disease. There is less delay in operation following diagnosis than ever before. Diagnosis is being made early in those with symptoms. Asymptomatic calculi are being revealed more frequently by complete over-all medical evaluations including cholecystography. Acute obstructive cholecystitis, a complication of cholelithiasis, is becoming less frequent in proportion to the total patients admitted to hsopitals. The operative mortality is concentrated among those in the elderly group, 65 years old and older. The limited capacity of many patients in this category to tolerate the burden of any surgical procedure is being met by palliative, temporary procedures such as cholecystostomy and ductal decompression rather than definitive cholecystectomy and choledochotomy. Roentgenologic facilities are becoming available to provide visualization and critical evaluation of the entire ductal system at the beginning of an operation. This provides a more realistic basis for common duct exploration, an increment associated with morbidity. More important is the assurance against overlooking calculi, retained ductal stones.