Acute cholecystitis.

The mortality rate for acute cholecystitis was 9.4 per cent. Those patients who underwent cholecystostomy had a mortality rate of 27.3 per cent, cholecystectomy 2.2 per cent, cholecystectomy and choledochotomy 7.4 per cent. Factors found to have an adverse effect on mortality in acute cholecystitis included sphincterotomy, perforation or gangrene of the gallbladder and cholagitis. Cholecystectomy is the operation of choice in acute cholecystitis in the absence of or history of jaundice or evidence of a common duct stone or cholangitis. Operative cholangiography and pressure and flow measurements through the cystic duct are advocated to avoid a retained common duct stone. Cholecystostomy should be reserved for the critically ill patient or a patient who deteriorates during operation, and it should be done only if the operator visualizes clear bile returning through the cystic duct.